Hospital off-campus outpatient department enrollment requirements

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Home ► PE Tips and tutorials ► Hospital off-campus outpatient department enrollment requirements

Last Modified: 4/1/2024 Location: FL, PR, USVI Business: Part A

Hospital off-campus outpatient department enrollment requirements

Under Section 1833(t)(21) of the Social Security Act, providers must identify non-excepted services at an off-campus, outpatient, provider-based department of a hospital. Non-excepted services provided at an off-campus, outpatient, provider-based department of a hospital are paid under the Medicare physician fee schedule (MPFS), not the outpatient prospective payment system (OPPS) rates.

Claim edits were implemented to validate the location you are providing services is a Medicare-enrolled location. Providers should ensure their off-campus, outpatient departments are listed on their enrollment record. The location on your claim must match the location on your enrollment record location exactly.

To add a new or revise an existing location, complete a change of information enrollment application:

• Online through PECOS external link

• Or paper-based Medicare Enrollment Application - Institutional Providers (CMS-855A external pdf file

)

In the hospital practice location section, there is a field to indicate your type of practice location. It is imperative to provide the appropriate practice location type. If the type is not listed, mark Other and provide the correct type of practice location in the free-form field (e.g. emergency department, off-campus department, on-campus, remote, etc.).

Note: If your organization is going through a change of ownership (CHOW), merger, or consolidation, the effective date of each practice location should reflect the date the location was established and not the date of sale.

To verify your enrolled, active practice locations:

• Access direct data entry (DDE): Provider practice address query - Option 1D

• Review current Medicare information on PECOS external link

• Call provider enrollment

For specific claim editing information, please visit:

• Hospital off-campus outpatient department reporting requirements

• MLN Matters article SE19007 external pdf file

, Activation of validation edits for providers with multiple service locations

• MLN Matters article SE18002 external pdf file

, Billing requirements for OPPS providers with multiple service locations

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