New Edit for PPS Outpatient and Inpatient Bill Types Receiving an Outlier Payment when Device Credit is Reported
On July 7, 2022, The Centers for Medicare and Medicaid Services (CMS) issued Change Request (CR) 12769 to suspend outpatient and inpatient prospective payment system (OPPS and IPPS) claims getting an outlier payment when a device credit is reported. This edit will allow Medicare Administrative Contractors (MACs) to review the charges and validate Medicare outlier device amounts for fully or partially credited devices. While there is no policy change, the edit will go into effect January 1, 2023.
