Under CMS’s Exact Matching plan, starting July 1, 2019, when hospitals submit claims to Medicare with mismatched addresses, those claims will be returned unpaid. Hospitals will not be paid unless the conditions of the new exact matching plan are met in full. The addresses which hospitals use on their claims for services provided at off-campus, outpatient departments are required to exactly match the address used on their Medicare enrollment forms at those same locations.
Hospitals that do not match their off-campus HOPD addresses with 855A enrollments can expect to have their claims Returned-To-Provider (RTP). Unless they follow the exact matching rule guidance to the letter, under the new plan hospitals stand the risk of losing millions of dollars. At the very least, hospitals might end up waiting long periods of time to receive their money.
The new Exact Matching Rule Guidance is very stringent when it comes to having addresses that match. With the new exact matching plan, words like “street” or “road” submitted as “St.” or “Rd.” will be enough to cause claims to be rejected.
Moreover, RTP claims must get filed in an expedited manner upon receipt. These claims have been deemed erroneous and will not be processed. In order to resolve RTP claims, hospitals will be required to revise the claim and then resubmit the claim. Advis’ own Monica Hon, Vice President and expert in healthcare consulting weighed in on the new rule in the latest issue of Modern Healthcare. Read more to get her perspective and to learn more about what impacts the rule is expected to have in the industry.
To help prevent cash flow problems in health systems, Advis’ leading provider enrollment experts have developed a free, easy reference tool to assist compliance with the new Exact Matching rule. The tool uses a high-level summary of mandatory line level modifiers and claim level location identification fields to assist in ensuring exact match identification. To have the Exact Matching Plan more fully explained, or for additional Exact Matching Rule Guidance, please click here.
Advis is a nationally-recognized expert in institutional billing, 855a enrollment guidance, coding requirements, and provider enrollment. In additional to provider enrollment expertise, we are likewise Medicare enrollment specialists. Advis helps solve cash flow problems for health systems. For more information on Exact Matching Rule Guidance, or for assistance in implementation and/or review of your processes, please fill out our form or call Advis at (708) 478-7030.