CHA News

CMS Postpones Billing Edits for OPPS Providers With Multiple Service Locations

Providers must ensure their claims data match enrollment information

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The Centers for Medicare & Medicaid Services (CMS) has postponed billing edits for outpatient providers with multiple service locations — scheduled to start in April — for three additional months.

CMS has postponed full implementation of the edits to allow providers time to adjust to a new Provider Enrollment, Chain and Ownership System (PECOS) practice location screen. The screen will be available for providers to check in the April quarterly release. Additional testing will occur in June to ensure providers have used the tool and made any necessary claims submission updates. Once CMS implements the July 2019 quarterly release, Medicare administrative contractors will be directed to permanently turn on edits and return claims that do not exactly match.

CHA reminds members that Medicare systems must validate the service facility location to ensure services are being provided in a Medicare-enrolled location. This validation will be exact matching based on the information submitted on the Form CMS-855A submitted by the provider and entered into PECOS. Providers need to ensure that the claims data match their provider enrollment information.