tci Medicare Compliance & Reimbursement - 2019 Issue 12

Reimbursement: Match Addresses Exactly for Off-Campus Claims or Risk Denials

Tip: Review what’s in PECOS as soon as possible. If you’re already worried about denials, here’s another item to add to your claims checklist. The Centers for Medicare and Medicaid Services (CMS) is slated to reject hospital claims for Medicare services furnished at off-campus provider-based departments (PBDs) when the addresses don’t match up exactly with what’s in Provider Enrollment, Chain and Ownership System (PECOS) — starting in July. Background: The timeline for this address implementation is significant and started with site-neutral requirements outlined in the Bipartisan Budget Act of 2015 (BBA 2015). In fact...

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