Medicare Service Facility
Location Address Edits DELAYED
On Tuesday, March 24, 2020, the Centers for Medicare and Medicaid Services (CMS) made an announcement that systematic edits for the Outpatient Prospective Payment System (OPPS) providers with multiple service locations are  POSTPONED . Edits were expected to go into effect in April 2020, but the CMS released a revised  MLN Matters SE19007  stating that edits were delayed until further notice.

The CMS is requiring that the service facility location address for off-campus, outpatient, provider-based departments be reported on the claim. Full instructions can be found in the MLN Matters Articles linked below. Medicare will cross reference the address reported on the claim with the facility locations on file in the Provider Enrollment, Chain, and Ownership System (PECOS) in order to ensure that services are being performed in an enrolled Medicare location.
If your hospital has off-campus provider-based departments, you should ensure the following for accurate submission of claims:

  • The hospital’s CMS-855 enrollment is up to date and all off-campus provider-based facilities are accurately listed with the department name and address down to the suite number level in PECOS.

  • The hospital billing system is set up to include service facility locations in the 2310E loop of the 837 institutional claim transaction.

  • The addresses generated on the claim EXACTLY match what is listed on PECOS.

  • PO/PN modifiers are properly included on claims for off-campus, outpatient hospital departments.
Please contact us for assistance on CMS-855 enrollments, provider-based facilities, or general questions on this Medicare regulation.
Sara Bing, MHA
Health Care Manager
614.223.9209 x3713 sara.bing@actcpas.com
Myranda Pike, CPC, CHC
Health Care Manager
304.346.0441 x3394 myranda.pike@actcpas.com
Karen Robinson, CPS, CHC
Health Care Manager
614.223.9209 x3702