A hospital must submit a single per location request to their CMS Regional Office within 120 days of beginning to furnish and bill for services at the relocated PBD.
A version of this article was first published January 25, 2021, by HCPro's Revenue Cycle Advisor, a sibling publication to HealthLeaders.
Q: What information must be submitted to CMS to quality a patient's home as a relocated provider-based department (PBD)?
A: To relocate a PBD to an off-campus location (including a patient’s home) and justify its eligibility for full OPPS payment, a hospital must submit a single per location request to their CMS Regional Office within 120 days of beginning to furnish and bill for services at the relocated PBD. The request must include the following information:
- The hospital’s CCN
- The address of the current PBD
- The address(es) of the relocated PBD
- The date when they began furnishing services at the new PBD
- A brief justification for the relocation and the role of the relocation in the hospital’s response to COVID-19
- An attestation that the relocation is not inconsistent with their state’s emergency preparedness or pandemic plan
The hospital should follow these billing rules, whether the PBD was expanded or relocated:
- Bill under the existing hospital CCN
- Bill with type of bill (TOB) 13X or 85X, as applicable
- Report the main hospital’s address and NPI
- Report condition code DR (disaster relief, which is used at the claim level when all services/items on the claim are related to the emergency or disaster) or modifier -CR (catastrophe/disaster relief, which is mandatory for a line item if Medicare payment for the item or service is conditioned on the presence of a formal waiver, or as required by CMS or a MAC to correctly process claims), as appropriate
For more information, see "Note from the instructor: Creative delivery of outpatient hospital services during the COVID-19 PHE, Part I" by Judith Kares, JD.
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