June 28, 2016
If you have been experiencing problems with your RHC CCM claims being paid incorrectly, the corrective action to “fix” the CMS claims processing system is schedule to be installed on July 11th. CMS has released the following statement. Note that the MAC should automatically reprocess any CCM claims that were paid the incorrect amount and no refiling of the claims on the part of the RHC is required.
Chronic Care Management Payment Correction for RHCs and FQHCs:
Effective January 1, Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) began receiving payment for Chronic Care Management (CCM) services. Payment should be calculated based on the Medicare Physician Fee Schedule national average non-facility payment rate. CMS is aware that RHCs and FQHCs have been receiving a locality adjusted payment rate for CCM services. Your Medicare Administrative Contractor will adjust any claim processed incorrectly. No provider action is required.
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