Medicare outpatient claims-processing changes delayed till October: 5 things to know

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CMS has delayed for three additional months full implementation of Medicare outpatient prospective payment system claims edits for services provided by departments of hospitals and health systems.

Five things to know:

1. The system edits apply to providers with off-campus, outpatient, provider-based departments.

2. They require Medicare outpatient service providers to include on claims the same provider address for services rendered at an off-campus, outpatient, provider-based department as the one entered in the Medicare Provider, Enrollment, Chain and Ownership System for that location, according to the American Hospital Association.

3. The edits were slated to take effect in July, but full implementation has been delayed until Oct. 1.

4. "CMS has completed round 3 testing. We are in the process of analyzing the data, but at this point we have discovered no major issues during round 3 testing. Based on stakeholder comments and to allow additional time to review the round 3 testing, however, CMS has decided to postpone full production implementation for three additional months until October 2019," the agency said.

5. CMS said the testing was to ensure hospitals and health systems have used the new practice location screen tool and updated claims submission as needed.

Read more about the system edits here


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