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CMS could reject outpatient claims over spelling, abbreviations — 3 things to know

Healthcare organizations will encounter an additional barrier to payment for Medicare outpatient claims this summer, according to JD Supra.

Three details:

1. Beginning in July, CMS will reject a Medicare outpatient claim if:

  • The service location address doesn't exactly match the address listed on the 855A enrollment form in the Provider-Enrollment, Chain and Ownership System
  • A hospital with multiple locations doesn't report the correct location where the service was rendered

2. The guidance means spelling differences or abbreviations — such as "Rd." instead of "Road" — can cause an outpatient claim to be rejected.

3. CMS created a query function allowing hospitals to cross-check their claim addresses with the ones listed in PECOS. JD Supra advised hospitals to immediately begin reviewing the records "so as to avoid potential roadblocks."

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