Fiscal Intermediary Shared System (FISS) - Restrict the Maryland Waiver Indicator (MWI) to State Codes 21 and 80
While making the 2021 rate updates for Prospective Payment System (PPS) exempt providers, several Medicare Administrative Contractors (MACs) encountered a FISS file maintenance edit that ensures updates to the core Provider file are consistent with the provider type and reimbursement method. To resolve the FISS edit, the MAC incorrectly set the MWI to Yes which caused FISS to identify the provider as participating in the Maryland Waiver demonstration. Hard coded logic in FISS reimburses Maryland Waiver hospital claims as a percentage of billed charges. This resulted in several large overpayments before the error was identified and corrected. This change will create a new FISS file maintenance edit to ensure that FISS will only accept a 'Y' in the MWI if the provider is located in Maryland.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: August 11, 2021
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