New Edit for Prospective Payment System (PPS) Outpatient and Inpatient Bill Types Receiving an Outlier Payment When a Device Credit is Reported
The purpose of this Change Request (CR) is to implement 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.
Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: July 07, 2022
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