Incorrect MTM Billing Codes Leading to Zero Reimbursement

$2,000-$15,000 monthly (per location) in documented zero-reimbursement MTM codes + lost revenue from staff decisions to shorten visits to avoid 99607 = $24,000-$180,000 annually per pharmacy • $34-$130 per 99607 unit × average 4 units per patient per day × patient volume = $2,720-$10,400 monthly revenue loss per pharmacy location • $34-$130 per service unit unbilled + reputation risk if state audits find underbilled services or compliance violations = $50,000-$200,000 annually per location in potential audit liability

Excel spreadsheets and manual claim tracking to document 99607 units submitted at $0 reimbursement; paper-based reconciliation of 'compliant but unpaid' claims; WhatsApp coordination with pharmacy manager to confirm which units were billed vs. received payment • Informal time rounding (billing 15 min instead of 30-45 min to avoid 99607 submission); collaboration with billing team via casual conversation to determine which services 'actually get paid'; mental tracking of which patient visits to 'not fully bill' • Manual analysis of claim reports; coordination calls with billing team and state Medicaid to 'verify' that this is expected (i.e., confirms the leak is intentional/required); potential pressure on staff to reduce MTM visit lengths to avoid 99607; spreadsheet tracking of 'lost reimbursement' as separate line item in revenue reports