MACs to Adjust RHC Payment Error

Nathan Baugh, Executive Director


JUNE 22, 2023 ~ UPDATE

NARHC has confirmed with CMS that the MACs will be adjusting payments and no action will be needed from rural health clinics. We believe that each MAC will issue a notification acknowledging the issue and describing how they will rectify the error.

We believe that most, if not all, of the MACs will be initiating mass adjustments for the improperly processed claims.

NARHC will post the links from the MACs regarding this issue as we have them.

Original Article (June 8, 2023)
Medicare Currently Incorrectly Paying RHC Claims

NARHC is aware of an issue, likely caused by a Fiscal Intermediary Standard System (FISS) update, that is causing Medicare Administrative Contractors (MACs) to reimburse RHCs incorrectly.

The issue appears to impact Medicare claims submitted in early to mid-May and causes Medicare to pay the difference between the RHC’s All-Inclusive Rate (AIR) and the patient’s coinsurance. This stands in contrast to Medicare’s longstanding policy wherein RHCs receive reimbursement equal to 78.4% of their AIR for every single Medicare encounter after deductibles have been met.

This is a technical glitch that the MACs and the FISS must fix. The reimbursement policy has not changed.

Our understanding is that the MACs have escalated this issue with the FISS and all parties agree that the reimbursement is not working as it should. While this consensus is a positive first step, it is unclear how quickly the FISS and the MACs will be able to rectify payments. NARHC will remain engaged on this issue until it is appropriately resolved.

We have received conflicting information on whether this issue applies only to independent RHCs, or all RHCs. We suggest that all RHCs review Medicare claims submitted in May/June to see if this has impacted your reimbursement.

We will continue to post updates on as we have them.

National Association of Rural Health Clinics