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Starting on August 1, 2023, Medicare validation edits will be activated to require service location addresses on the UB-04 hospital claim form to match exactly with the service location enrolled in Medicare’s Provider Enrollment, Chain, and Ownership System (“PECOS”).
Background
In a previous article, we reported on the Center for Medicare & Medicaid Services (“CMS”) implementation of new billing edits that will Return to Provider any hospital UB-04 claims that identify a service location that is not an exact match to a Medicare-enrolled location identified in PECOS. The implementation date was set to begin in April 2020 but was delayed due to the COVID-19 Public Health Emergency.
In a recent article dated July 11, 2023, CMS announced that the edits will be activated on August 1, 2023. As part of the requirements, hospitals must report the service facility location for an off‑campus outpatient provider-based department of a hospital in the 2310E loop of the 837 institutional claim transaction (i.e., UB claim). Medicare claim systems will validate the service facility location to make sure the service location is a Medicare-enrolled location in PECOS. Effective August 1, 2023, Medicare Administrative Contractors will begin returning claims where the service location on the claim does not match exactly to the PECOS enrolled location.
Practical Takeaways
- Hospitals should act now to review their PECOS enrollment files and ensure all hospital and off-campus outpatient department locations are enrolled accurately. All updates to service locations should be submitted via the PECOS application or the paper 855A form.
- Hospitals should ensure claim software is updated to allow UB-04/837 claims to drop with the service location identified exactly as it appears in PECOS.
If you have any questions or would like additional information about this topic, please contact:
- Regan E. Tankersley at (317) 977-1445 or [email protected];
- Brian D. Jent at (317) 977-1402 or [email protected];
- Lauren G. Hulls at (317) 977-1467 or [email protected]; or
- Your primary Hall Render contact.
Special thanks to Becca Foerder, summer associate, for her assistance with the preparation of this article.
Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot—outside of an attorney-client relationship—answer an individual’s questions that may constitute legal advice.
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