HOSPITALS MAY SEE CASH FLOW INTERRUPTIONS WHEN NEW POLICY TAKES EFFECT
When CMS’s Exact Match plan goes into effect in July, 2019, hospitals failing to match off-campus HOPD addresses with 855A enrollments can expect to have their claims Returned-To-Provider (RTP). The returned claims could prove to be financially troublesome for hospitals. The claims will not be formally acknowledged as received, thus causing possible cash flow issues. Timely filing deadlines are needlessly jeopardized.
Unlike rejected or denied claims, RTP claims need to be filed in an expedited manner. RTP claims are considered to be erroneous and cannot be processed. Hospitals will have to resolve the mismatch issue prior to resubmitting claims. A correction may take a significant amount of time, depending on MAC processing, as well as the additional time needed for electronic medical record systems to make the change.
Advis has developed a free, easy reference tool to assist with CMS’s new Exact Matching initiative. The tool uses a high-level summary of mandatory line level modifiers and claim level location identification fields to assist in ensuring appropriate identification. Fill out the form to the right to receive the tool.
Advis is a nationally-recognized expert in both institutional billing and coding requirements and provider enrollment. For more information on these requirements, or for assistance in implementation and/or review of your processes, please contact our offices at (708) 478-7030.