Incorrect Medicare addresses will delay payments starting July 1

June 13, 2019

Not sure if the address you’re using to bill Medicare matches up exactly to what CMS has on file? No big deal if you’re using different street abbreviations rather than spelling out the full word, right? Well, beginning July 1, those minor discrepancies could cost your hospital big time.

That’s when CMS will begin requiring hospitals to comply with its exact match program. The program, which was launched in a test phase last summer, requires the addresses hospitals use on their claims for services provided at off-campus, outpatient departments exactly match those entered for its Medicare enrollment of those locations.

During that test phase, some participants were surprised to learn that minor things, such as writing out “street” instead of abbreviating to “St.”, was enough to have claims returned. This means it’s crucial to know exactly what addresses CMS has on file for your Medicare enrollment across various locations.

If the addresses don’t match, hospitals will receive a return-to-provider notice. They will then have to work with their Medicare administrative contractor to resubmit the claims. The process could take some time, which may result in temporary cash flow problems.

Failing to get your claims resubmitted in a timely manner from the original date of service, will prevent you from receiving payment altogether!

This change is was generated by CMS’s site-neutral payment policy, which pays providers the same regardless of where they’re located. Services provided at non-grandfathered hospitals’ off-campus, outpatient departments are reimbursed the same on average as physicians’ office payments and not under the higher hospital rates.

Off-campus outpatient departments that hospitals operated before Nov. 2, 2015, are grandfathered under the new law, which means they receive the higher hospital rates.

In that light, exact match aims to ensure CMS is paying departments at the correct rates. Under the new rule, hospital outpatient departments are paid 40 percent of their grandfathered peers.

If you’re struggling with this updated rule, or questioning how you can update your addresses with CMS, don’t hesitate to reach out to us for assistance at 517-486-4262.

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