Implementation of CMS “Exact Match” Outpatient Edits Delayed to Oct. 1

Posted on July 02, 2019

The Centers for Medicare & Medicaid Services (CMS) recently announced a delay in the proposed July 1 activation of the “exact match” edits for Medicare fee-for-service (FFS) outpatient prospective payment system (OPPS) claims for services provided at off-campus hospital outpatient departments. Implementation is now scheduled to take effect Oct. 1.

These edits will require hospitals and health systems with multiple locations to ensure that claim forms show provider information that is identical to that entered in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) for that location. Medicare FFS OPPS claims will return to provider if the information on the claim does not exactly match the information in the PECOS. Providers are encouraged to review their enrollment information in PECOS to ensure an exact match, including all punctuation. Members with questions should contact Vickie Kunz at the MHA.

Tags: HOPD, OPPS, off-campus hospital outpatient departments, RTP, PECOS, exact match, address

Posted in: Member News

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