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CMS Delays OPPS Address Match Requirements

The Centers for Medicare & Medicaid Services (CMS) delayed until October enforcement of a requirement that hospitals with multiple service locations enter the service facility address on their claims, including for services provided at off-campus provider-based departments.

Under the requirement, the address a hospital lists on a claim will have to exactly match CMS enrollment records for the hospital to receive payment through the Outpatient Prospective Payment System.

CMS began testing this requirement in July 2018 and found that many hospitals did not send the exact service facility location that matched a Medicare-enrolled location for off-campus, provider-based departments. Common errors included abbreviations, such as spelling out “Road” instead of using “Rd.”

CMS previously announced the requirement would go into effect in July. Following stakeholder feedback, the agency postponed implementation to further review the testing results.

Beginning in October, CMS will direct Medicare administrative contractors to return claims to the provider if addresses are not an exact match.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Rachel Schwartz is a policy associate at America's Essential Hospitals.

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