Bad connection: MACs accidentally cut pay for telehealth in the patient’s home

by: Julia Kyles, CPC Mar 5, 2024

Check your payments for telehealth services reported with place of service 10 (Telehealth provided in patient’s home) after Jan. 1, 2024. If your MAC paid the facility rate that’s a big mistake. Your Medicare administrative contractor (MAC) should pay the non-facility rate when the patient is at home during a telehealth service.

You will have to take a wait-and-see approach if your MAC did shortchange you. For example, you should not resubmit claims with a different POS or open an appeal.

The following MACs have identified the problem and are working to fix it:

CGS Adminstrators and Palmetto GBA have not reported the issue, which could be a sign that the two MACs successfully updated their software to handle claims with place of service 10. However, if you submit claims to either MAC, check your remittance advice, just in case. And if you find a problem, don’t assume someone else will say something. Contact your MAC directly.

If you’re in a jurisdiction that was impacted by the error, keep an eye on your MAC’s claims issues page and your remittance advice to make sure you receive full reimbursement. Reach out to your MAC if you still haven’t been paid when it closes out the issue.

Blog Tags: claims processing, MACs, telehealth

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