MAC: New claims issue causing incorrect payment adjustments

Effective Jun 2, 2022

Published Jun 2, 2022

Last Reviewed Jun 3, 2022

A new issue is causing incorrect partial payment adjustments on some claims, according to Medicare Administrative Contractor (MAC) Palmetto GBA.

The MAC noted in an alert June 1, 2022, that the issue was being researched and no provider action is needed at this time.

According to Palmetto, partial period payment adjustments should only occur as a result of the following situations:

When a patient has been discharged and readmitted to home care within the same 30-day period of care; or
When a patient transfers to another HHA during a 30-day period of care; or
In cases where the patient elects Medicare Advantage (MA) coverage during an HH PPS period of care.

See more at the Palmetto payment issues log at https://bit.ly/38MZbYN.

This issue has not been published at the issues logs for the other MACs, but you can monitor here:

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