Pam Warren
True Blue
This came out Monday in response to the many questions about TCM.
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Wiki Attached from CMS: Transitional Care Management FAQs
- Thread starter Pam Warren
- Start date
rjboisvert72
Guest
Billing/Insurance Coordinator
I understand that we can not bill these codes for at least 30 days. What I need to know is how do I bill them when the time is up? Meaning the 29 days are done and it is the 30 day?
I understand that we can not bill these codes for at least 30 days. What I need to know is how do I bill them when the time is up? Meaning the 29 days are done and it is the 30 day?
Pam Warren
True Blue
Bill so that the DOS is day 30 after discharge.
rjboisvert72
Guest
I understand that, but we can not change the date of service, that would be illegal and fraud. So what you are saying is refile the claim on the 30th day with the original date of service.
Pam Warren
True Blue
No, it's not fraud, and please don't infer that I'm suggesting that. You're confusing the date of the face to face with the date of the TCM. The TCM represents 30 days post-discharge service. So you report that 30 day service, by using the day 30 as the date of service. The face to face is bundled in, and CMS doesn't want you to report that DOS. The code you select tells CMS whether the visit was up to 7 days or up to 8-14 days from discharge.
You'll get a claim denial if you bill your TCM fewer than 30 days post-discharge, because CMS knows the discharge date.
You'll get a claim denial if you bill your TCM fewer than 30 days post-discharge, because CMS knows the discharge date.
nmalpass
Guest
Question about TCM
Can a medical assistant in direct contact with the physician do the 2 day follow up after discharge?
Can a medical assistant in direct contact with the physician do the 2 day follow up after discharge?
Pam Warren
True Blue
Yes. TCM services are designed to use ancillary staff (typically RN Care managers), under the supervision of the physician. They cannot, however do the face-to-face.
rjboisvert72
Guest
Thank you, I will try doing that and see what happens. I have some that are 30 days in..
kbarron
Guest
@ Pam...how would this work with a Hospitalist? We do not have any PCP admit or D/C patients. (except Pedi Practice, they admit their own.)