CMS has issued a warning that some Medicare Administrative Contractors (MACs) are rejecting certain telehealth claims submitted after October 1 due to system processing issues. If your dermatology practice delivers telederm services, you may have claims sitting in denial that need to be resubmitted.
What’s Happening
The issue stems from MAC processing system updates that went into effect October 1. Some telehealth claims that would normally process correctly are being rejected due to how the updated systems are handling Place of Service codes and telehealth modifiers.
This is not a policy change — it’s a technical processing error. The services are covered; the claims are just being incorrectly flagged by updated MAC systems.
If you submitted telehealth claims after October 1 and received unexpected denials or rejections, this processing issue may be the cause. Don’t assume the denial is valid — check whether it matches the known MAC processing issue before adjusting your billing.
What to Do
- Pull all telehealth claims submitted after October 1 that were denied or rejected
- Check denial reason codes — look for rejections related to POS codes, telehealth modifiers, or “service not covered” on services you know are covered
- Resubmit affected claims — CMS has indicated that resubmission should resolve most of these processing errors
- Document the MAC issue in your appeal if a resubmission is denied again
- Monitor your MAC’s communications for updates on when the processing fix is complete
Prevention Going Forward
This situation reinforces why every dermatology practice needs a systematic telehealth billing workflow that includes:
- Payer-specific POS code verification before submission
- Automated flags for telehealth claims that receive unexpected denials
- A process to batch-check and resubmit claims when MAC processing issues are announced
- Subscription to MAC notifications for your jurisdiction
Key Takeaways
- MAC system updates after October 1 are causing telehealth claim rejections
- This is a processing error, not a policy change — services are still covered
- Pull all post-October 1 telehealth denials and resubmit
- Monitor your MAC for processing fix updates
- Build systematic telehealth billing workflows to catch issues faster