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Location Matters Update: CMS Postpones Exact Match Billing Rule – AGAIN

Posted on July 2, 2019 in Health Law News

Published by: Hall Render

In a previous article, we reported on CMS’s 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 Provider Enrollment, Chain and Ownership System (“PECOS”). As previously reported, those edits were scheduled to be activated on April 1, 2019 but were delayed until July 1, 2019.

On the Friday before the July 1, 2019 implementation date, CMS released a revised version of MLN Matters Article SE19007, which postponed implementation of these edits once again until October 2019. In the meantime, CMS will continue to analyze the round three testing data, despite reporting no major issues during round three testing.

Providers should utilize this additional time to confirm that their PECOS files are updated and their billing systems can handle these new requirements.

If you have any questions or would like additional information about this topic, please contact:

Special thanks to Spencer Hatfield, law clerk, for his assistance with this publication.