McGuireWoods’ Fry and Roenius Explain New Medicare Address Requirements for Hospital Outpatient Locations

June 14, 2019

Prominent healthcare publications turned to McGuireWoods Chicago associates Timothy Fry and Amanda Roenius for insight on how a change to Medicare’s claims processing requirements will affect hospitals that fail to provide accurate and consistent outpatient address information to Medicare contractors.

Fry and Roenius discussed the issue in a May 31 story in Healthcare Financial Management. Modern Healthcare also quoted Fry in a June 1 story on the issue. Fry and Roenius are members of the firm’s healthcare practice.

Beginning in July, the Centers for Medicare & Medicaid Services (CMS) will begin enforcing a requirement that the addresses hospitals use on claims for services at off-campus outpatient facilities exactly match those entered in Medicare enrollment of those facilities. If the addresses do not match, hospitals will receive a return-to-provider notice and must resubmit their claims, potentially delaying reimbursement.

Fry told Modern Healthcare that most address discrepancies are accidental and that CMS delayed implementation of the rule until July so hospitals could take the steps needed to comply.

“But do I expect that a lot of our hospitals are going to be 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? Absolutely.”

In the Healthcare Financial Management article, Roenius expressed hope that hospitals could comply with the requirement without making changes to their enrollment forms.

“What we’re hoping is that it is going to [involve] updating the claims they send in, making sure that their claims match enrollment information that has already been provided to CMS,” she said.