Industries & Practices

Health Care Law


    Turcotte discusses billing addresses and Medicare payments in HFMA publication

    With the July deadline quickly approaching, health care entities are encouraged to quickly resolve inconsistencies with their facilities’ addresses. As discussed in a recent Bricker Health Care Alert, The Centers for Medicare & Medicaid Services (CMS) has warned that address discrepancies between a service facility location on a claim and the enrolled location found in the PECOS system may be a cause for denied or delayed payments.

    In a recent publication, the Health Care Financial Management Association (HFMA) gives further details, as well as the reasoning behind this change. According to CMS, the confirmation of facility addresses should help ensure the “correct use of the modifiers and correct payment.” Bricker attorney Claire Turcotte provides additional information, stating that  “[t]hey’re trying to ensure records are correct so that they pay the higher outpatient rates only at the locations that qualify.”

    Health care entities will not only need to update their records but will also likely see an effect on their operations and workflow. Turcotte adds that “[f]or many years, hospitals were kind of lax in updating that information because CMS wasn’t tracking off-campus locations, specifically, until a few years ago. If someone at the health system hasn’t been maintaining those records and didn’t start cleaning them up in 2015, there could be quite a bit of work to do because some larger systems have hundreds if not thousands of these locations.”