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CLIENT ALERT: Medicare Providers having multiple locations should verify and revalidate their address information to avoid claim denials

Client Alert

MLN Matters SE19007 “Activation of Systematic Validation Edits for OPPS Providers with Multiple Service Locations” notifies providers that Medicare is now requiring the exact match of all addresses for practice locations that are listed on provider claim submissions to Medicare. (See attached)

Medicare began auditing in July 2018 for purposes of reinforcing Chapter 1, Section 170 of the Medicare Claims Processing Manual “Payments on the MPFS for Providers with Multiple Service Locations.”  The exact address match will be in full and effect once the July 2019 quarterly release is implemented.

Claims that do not have an exact address match will be returned to the provider.  Providers can make corrections to their service facility address for a claim submitted in the DDE MAP 171F screen for DDE submitters.

It is recommended that providers review their Medicare enrollment record and billing practices to ensure compliance with the exact address match requirement.  Medicare recommends that all providers update their billing records to match Medicare enrollment records.  Providers should verify and submit changes through the CMS-855A or CMS-855B application through the Provider Enrollment, Chain, and Ownership System (PECOS) as soon as possible.  Changes and updates to an address or the addition of a new location typically take Medicare 30–60 days to process.

If you would like copies of the regulations, need legal assistance with updating your Medicare enrollment information, or have any questions concerning these matters, please contact Amanda Waesch at 330-253-9185 or via email at alwaesch@bmdllc.com.


Patient Abandonment and Termination

Healthcare professionals have a responsibility to patients with whom they have established a treatment relationship. However, there may be some instances when they will need to terminate their relationship with a patient. FAQs for patient abandonment and termination are provided to help guide physicians.

A Business or Person Who Owes You Money Has Filed for Bankruptcy. Now What?

When you receive a notice that someone you do business with has filed for bankruptcy, it is important to act quickly to determine your rights in the bankruptcy process and to protect them. Here are seven things to do right away.

Recent Litigation Challenges the Affordable Care Act Preventive Services Requirement

The Affordable Care Act (ACA) has been met with numerous legal challenges. The most recent legal challenge, Braidwood Management Inc. v. Becerra, could affect millions of people covered by private health insurance.

340C – Prospective Legislation to Protect Federally Qualified Health Centers

Advocates for Community Health (ACH), an organization created to implement policy and advocacy initiatives for health care systems across the United States, has begun drafting legislation that is geared towards protecting Federally Qualified Health Centers (“FQHCs”) enrolled in the 340B Program, which is being dubbed “340C.”

Getting Paid to Vote

Can you get paid to vote? Election Day is upon us and employees across the country are asking whether they can get paid to vote. Essentially, can they take paid leave of a few hours to go to the polling location to cast their vote in a midterm election or presidential election. Well, it depends on the state where the employee works.