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:
- David H. Snow at (414) 721-0447 or email@example.com;
- Lori A. Wink at (414) 721-0456 or firstname.lastname@example.org;
- Regan E. Tankersley at (317)-977-1445 or email@example.com;
- Brian D. Jent at (317)-977-1402 or firstname.lastname@example.org;
- Joseph R. Krause at (414) 721-0906 or email@example.com;
- Lisa A. Lucido at (248) 457-7812 or firstname.lastname@example.org;
- Lauren G. Hulls at (317) -977-1467 or email@example.com; or
- Your regular Hall Render attorney.
Special thanks to Spencer Hatfield, law clerk, for his assistance with this publication.