Enrolling Hospital Outpatient Provider-Based Departments
Hospitals often have multiple service locations (including off-campus, outpatient, provider-based departments) in different payment localities. To ensure accurate payment for services provided at these locations, hospitals must enroll each outpatient provider-based department.
In the Practice Location Information section (section 4) of the enrollment application:
- Report each practice location address.
- For each address listed, select the appropriate practice location type (defined below).
- In PECOS, select "Other Health Care Facility". In the free-form box, enter the appropriate practice location type (defined below).
On Campus: The physical area immediately adjacent to the provider's main buildings, other areas, and structures that aren't strictly contiguous to the main building, but are located within 250 yards on the main buildings, and any other areas determined on an individual case basis to be part of the provider's campus. Hospital provider fulfills the obligations of hospital outpatient department.
Remote Location of a Hospital: A facility or organization that's either created by or acquired by a hospital that's the main provider for the purpose of providing inpatient hospital services under the name, ownership, and financial and administrative control of the main provider. A remote location of a hospital comprises both the specific physical facility that serves as the site of service of which separate payment could be claimed under the Medicare Program, and the personnel and equipment needed to deliver the services at the facility. The Medicare conditions of participation (CoPs) don't apply to a remote location of a hospital as an independent entity, per 42 CFR 413.65(a)(2).
Emergency Department: Per 42 CFR 489.24(b), a provider-based off-site hospital emergency department (ED) must demonstrate compliance with the hospital CoPs. They must also comply with the provider-based regulations at 42 CFR 413.65. A department or location can't be both an urgent care center and an ED unless they're distinct and separate – at a minimum, they must have different suite numbers.
603 Exception Department: Grandfathered by mid-build legislation or provider-based department (PBD) that relocates to a new location (either temporarily or permanently), without losing its excepted status, upon a demonstration of extraordinary circumstances outside of the hospital's control, such as natural disasters, significant seismic building code requirements, or significant public health and public safety issues. The "603 Exception Department" definition only applies to PBDs meeting either of the 2 above criteria (mid-build or relocation). It doesn't apply to an excepted off-campus PBD that's "grandfathered" for providing services billable under the OPPS before 11/2/2015. For an off-campus PBD that's excepted from Section 603 of the Bipartisan Budget Act of 2015 payment policy for providing services billable under the OPPS before 11/2/2015, enter "Off-Campus Department" as described under definition 7 below. The system will use the practice location's original effective date in PECOS to decide whether Section 603 payment policy applies. If the practice location's original effective date in PECOS is before 11/2/2015, claims will correctly process at the OPPS payment rate.
Non-OPPS Department: The practice location is a non-OPPS location. Rural emergency hospital (REH); opioid treatment program (OTP); therapy; ESRD; certain hospitals in Maryland that are paid under Maryland waiver provisions; Critical Access Hospitals (CAHs); Indian Health Service hospitals; hospitals located in American Samoa, Guam, and Saipan; and hospitals located in the Virgin Islands.
Mobile Facility and/or Portable Units: Practice location is a mobile facility or portable unit.
Off-Campus Department: The practice facility isn't located on the campus of the main provider (greater than 250 yards), and the hospital provider fulfills the obligations of hospital outpatient department. Off-campus PBDs that are excepted from Section 603 payment policy because the department provided services billable under the OPPS before 11/2/2015 are included in this definition.
For more information, please reference CMS MLN Matters Article SE19007 – Activation of Validation Edits for Providers with Multiple Service Locations
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