Skip to main content
Subscribe
  • Sign Up Free
  • Login
  • Subscribe
  • News
    • Current News
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Digital Health
    • Transformation
    • ESG
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Blogs
    • AI
    • Deals
    • Layoff Tracker
    • HIMSS 2023
  • Opinion
    • Breaking Bias
    • Commentaries
    • Letters
    • From the Editor
  • Events & Awards
    • Awards
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top Innovators
    • Diversity in Healthcare
      • - Luminaries
      • - Top 25 Diversity Leaders
      • - Leaders to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Digital Health Transformation Summit
    • ESG: The Implementation Imperative Summit
    • Leadership Symposium
    • Social Determinants of Health Symposium
    • Women Leaders in Healthcare Conference
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Diversity Leaders Gala
    • Top 25 Women Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Hospital at Home
    • - Workplace of the Future
    • - AI and Digital Health
    • - Future of Staffing
    • - Hospital of the Future (Fall)
  • Multimedia
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Sponsored Video Series - One on One
    • Sponsored Video Series - Checking In with Dan Peres
  • Data & Insights
    • Data & Insights Home
    • Hospital Financials
    • Staffing & Compensation
    • Quality & Safety
    • Mergers & Acquisitions
    • Data Archive
    • Resource Guide: By the Numbers
    • Surveys
    • Data Points
  • Newsletters
  • MORE+
    • Contact Us
    • Advertise
    • Media Kit
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Operations
May 29, 2019 03:16 PM

Hospitals have a month to fix Medicare addresses or go unpaid

Tara Bannow
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print
    Getty Images

    Most people don't put much thought into whether to spell out "Street" or use the abbreviated "St." in an address.

    Come July, though, hospitals that choose the wrong one won't get paid by Medicare, at least temporarily, for certain outpatient services. That's when the CMS will start enforcing its exact match program. It requires that the addresses hospitals use on their claims for services provided at off-campus, outpatient departments exactly match those entered for its Medicare enrollment of those locations.

    And when CMS says exactly, they mean exactly. In a test run last summer, the agency found a number of discrepancies—mainly minor things like writing out "suite" or "road" versus abbreviating them to "Ste." or "Rd." But even those would be enough to have claims returned.

    "That's how detailed this exact match is going to be," said Monica Hon, vice president with the healthcare consultancy Advis Group, which has helped hospitals prepare. "You wouldn't think they would be a big deal, but they are."

    If Christus Health Shreveport-Bossier hadn't cleaned up its claim addresses to match its Medicare enrollment addresses, the Louisiana system likely could have had millions of dollars in claims returned under the upcoming policy, CEO Isaac Palmer said. That's not counting the thousands of dollars it could have spent assigning someone to work on getting those claims paid.

    "It's a big deal," he said. "That's hard for hospitals to keep up with. We spend so much time on operations and quality and everything else. Keeping up with the intricate rules of CMS is tough."

    If the addresses don't match, hospitals will receive a return-to-provider notice. They will then have to work with their Medicare administrative contractor to resubmit the claims. The process could take some time, which may result in a temporary cash flow problem for some health systems, attorneys said.

    Worst-case scenario: It could prevent hospitals from filing the claims within one year from the date of service, as is required for payment under the Affordable Care Act, Hon said.

    The change supports the CMS' site-neutral payment policy, which is designed to pay providers the same regardless of where they're located. It holds that services provided at non-grandfathered hospitals' off-campus, outpatient departments are reimbursed the same in aggregate as physician's office payments and not under the higher hospital rates. It's being challenged in the form of a bill before the U.S. House of Representatives and in lawsuits.

    Off-campus outpatient departments that hospitals operated before Nov. 2, 2015, are grandfathered under the new law, meaning they still receive the higher hospital rates.

    Exact match is intended to ensure the CMS is paying departments at the correct rates. The agency is concerned, for example, that hospitals might have a grandfathered outpatient location on one floor of an office building, and then start practicing out of another floor in the same building, the latter of which would not receive the higher rate, said Timothy Fry, a healthcare associate with McGuireWoods in Chicago. Under the new rule, hospital outpatient departments are paid 40% of their grandfathered peers, he said.

    Fry said he doesn't think hospitals with discrepancies are trying to game the system; it's mostly accidental. The CMS has put implementation of the new rule on hold until July to ensure hospitals have had time to make the changes, he said.

    "But do I expect that a lot of our hospitals across the country are behind on this? Absolutely," Fry said. "And do I think a lot of hospitals will be scrambling in a few weeks if this rolls out? You bet."

    Once hospitals know which addresses need to be fixed, it takes 30 to 45 days to have Medicare administrative contractors approve changes to a providers' enrollment information, Hon said. Corrections are a lot easier and faster to make to a provider's own claims submission system, Fry said.

    The changes will be more difficult for larger health systems with many hospitals and outpatient locations than it will be for smaller systems, Hon said.

    "I think you're going to see more of these things falling through the cracks in the larger systems than you would with the smaller systems that don't have many off-campus locations," she said.

    Staff at Christus Health Shreveport-Bossier began preparing for the change last year, and Palmer said he doesn't foresee running into problems in July.

    "I'm hoping this is going to be like Y2K," he said.

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    092823-BPTW-Millennials-Firsthand 6.jpg
    Giving younger employees the tools to thrive
    092823-BPTW-Healthiest-Medical Properties Trust 2.jpg
    ‘Healthiest’ winners take a flexible approach to wellness
    Most Popular
    1
    Centene to lay off 2,000 workers
    2
    How health systems are battling price-gouging allegations
    3
    Senate advances bill to temporarily aid hospitals, health centers
    4
    Elevance, Blue Cross Louisiana halt $2.5B proposed deal
    5
    Tower Health to sell urgent care centers, close others
    Sponsored Content
    Daily Finance Newsletter: Sign up to receive daily news and data that has a direct impact on the business and financing of healthcare.
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Help Center
    • Advertise with Us
    • Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2023. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Digital Health
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • ESG
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Blogs
      • AI
      • Deals
      • Layoff Tracker
      • HIMSS 2023
    • Opinion
      • Breaking Bias
      • Commentaries
      • Letters
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Digital Health Transformation Summit
        • ESG: The Implementation Imperative Summit
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Hospital at Home
        • - Workplace of the Future
        • - AI and Digital Health
        • - Future of Staffing
        • - Hospital of the Future (Fall)
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Sponsored Video Series - One on One
      • Sponsored Video Series - Checking In with Dan Peres
    • Data & Insights
      • Data & Insights Home
      • Hospital Financials
      • Staffing & Compensation
      • Quality & Safety
      • Mergers & Acquisitions
      • Data Archive
      • Resource Guide: By the Numbers
      • Surveys
      • Data Points
    • Newsletters
    • MORE+
      • Contact Us
      • Advertise
      • Media Kit
      • Jobs
      • People on the Move
      • Reprints & Licensing