Newsletter Vol. 31, No.19

By October 1, 2021: Billing team must implement the following changes: (1) Update billing software to enforce the S5102_U1 modifier for on-site AMDC services and S5102 code (without modifier) for remote services; (2) Configure system rules to prevent billing both on-site and remote services on the same day for the same member; (3) Establish documentation requirements for remote service claims: proof of telephonic contact, meal/supply delivery, or face-to-face visit; (4) Train billing staff that claims are billed per diem and post-payment review will occur; (5) Notify all AMDC providers that they must limit remote services to maximum 3 days per calendar week and transition to 100% on-site services by June 30, 2022; (6) Coordinate with Managed Care Organizations to track service delivery changes and ensure proper authorization updates. Claims submitted without adherence to these rules will be subject to denial and post-payment recovery.