New Edit for Outpatient and Inpatient PPS Bill Types Receiving an Outlier Payment When a Device Credit is Reported

Related CR Release Date: July 7, 2022
Related CR Transmittal Number: R11488OTN
Related Change Request (CR) Number: 12769
Effective Date: January 1, 2023
Implementation Date: January 3, 2023

CR 12769 implements editing to suspend Outpatient Prospective Payment System (OPPS) and Inpatient Prospective Payment System (IPPS) claims receiving an outlier payment when a device credit is reported. This new edit shall provide a mechanism for the Medicare Contractors to review the charges and device reduction amount submitted on the claim for fully or partially credited devices.

Make sure your billing staff is aware of the changes.

View the complete CMS Change Request (CR)12769.

Last Updated Jul 13 , 2022