Providers with Multiple Service Locations See Activation of Validation Edits
After being delayed multiple years and completing five rounds of testing, the Centers for Medicare and Medicaid Services (CMS) will begin deploying validation edits for providers with multiple service locations beginning August 1, 2023.
There are an increasing number of hospitals which operate off-campus, outpatient, provider-based departments of the hospital. Since there is the possibility for these additional locations to be in a different payment locality than the main provider, CMS uses the service facility address of the off-campus, outpatient, provider-based department to determine the locality. CMS also requires non-excepted services provided at these locations to be identified, so that the payment rate for non-excepted items and services billed are paid under the Medicare physician fee schedule (MPFS), and not the outpatient prospective payment system (OPPS).
Medicare will validate service facility locations to ensure services are being provided in a Medicare-enrolled location. Validation of claims submission will be exact matching based on the information on the CMS-855A form submitted by the provider and entered into PECOS. Claims data must match PECOS data.
Medicare Administrative Contractors (MACs) were tasked with developing implementation plans to permanently implement the six reason codes and ensure claims that do not exactly match are returned to provider (RTP). Some MACs have set up different implementation timelines, please visit your MACs website for further information.
