June 3, 2019

Do your addresses exactly match CMS’ files? If not, you could lose Medicare payments.

Daily Briefing

    Hospitals have about one month to ensure the addresses of off-campus and outpatient facilities exactly match what CMS has on file or risk missing out on Medicare payments.

    June 25 webcon: What you need to know about prevention of information blocking in 30 minutes

    According to Modern Healthcare's "Transformation Hub," CMS in July will begin requiring that the addresses hospitals submit on claims for services provided at their off-campus and outpatient facilities exactly match the address that was used to enroll those facilities in Medicare. CMS said it is making the change to help support site-neutral payment policies.

    If the addresses do not match, CMS will send the hospital a return-to-provider notice. During a test the agency conducted last summer, CMS returned claims for minor differences, such as claims using "St." instead of "Street" or "Rd." instead of "Road," "Transformation Hub" reports.

    Hospitals then would have to work with their Medicare administrative contractors to resubmit the claims—a process attorneys have said could be lengthy, and ultimately could create temporary cash flow issues for hospitals, "Transformation Hub" reports.

    In addition, hospitals that do not make the necessary corrections within one year of the date of service, which is required for payment, could miss out on payments altogether, according to Monica Hon, vice president with Advis Group, a consultancy group that has helped hospitals prepare for the change.

    Isaac Palmer, CEO of Christus Health Shreveport-Bossier, said the agency's test last summer showed that the facility could have missed out on millions of dollars in claims if it had not corrected addresses for its off-campus and outpatient locations. "It's a big deal," and one "[t]hat's hard for hospitals to keep up with," he said. Palmer explained, "We spend so much time on operations and quality and everything else. Keeping up with the intricate rules of CMS is tough."

    What should hospitals do if the notice discrepancies?

    Hon noted that it typically takes about 30 to 45 days for Medicare administrative contractors to approve changes to a providers' enrollment information.

    As such, Timothy Fry, a health care associate with McGuireWoods, said it likely is easier for hospitals to update their claims submission programs rather than the addresses used for Medicare enrollment.

    Ultimately, though, hospitals that have been preparing for the change likely will not see any problems. "I'm hoping this is going to be like Y2K," Palmer said (Bannow, "Transformation Hub," Modern Healthcare, 5/29).

    Cheat sheets: Medicare payment programs 101

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