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The Centers for Medicare & Medicaid Services (CMS) has found that hospitals are increasingly operating “off-campus, outpatient, provider-based” departments. Services provided at these off-campus facilities are required to be billed using the off-campus facility’s address so that payment can be accurately made under the Medicare Physician Fee Schedule (MPFS) or the Outpatient Prospective Payment System (OPPS).
Beginning in April 2019 — and no, this is not an April Fool’s joke — CMS will begin returning OPPS claims where the address on the claim does not match the exact address appearing on the hospital’s Form 855A.
And by “exact address,” CMS means the exact address on the 855A. A claim will be returned for using “Rd.” instead of “Road,” or “Ste.” instead of “Suite,” depending on how it was originally spelled on the 855A.
This should only affect OPPS providers with multiple practice locations. To avoid having claims returned, your hospital should ensure that the practice locations listed on its Form 855A are up to date and that any claims submitted match the address on file with CMS exactly.
This is also a good opportunity to review your hospital’s Form 855A and correct any information that is no longer accurate.