In a recent blog on TCM as a patient care strategy, we covered the essentials of TCM medical billing and the benefits of transitional care management (TCM). In this post, we share the TCM medical billing guidelines for medical practices and healthcare enterprises.
TCM Medical Billing Guidelines
Transitional Care Management (TCM) medical billing involves the process of billing for services provided to patients as they transition from an inpatient hospital stay to their home or another care setting. Here are some tips to help you with Transitional Care Management medical billing:
- Understand TCM Guidelines: Familiarize yourself with the specific TCM guidelines provided by the Centers for Medicare and Medicaid Services (CMS) or other relevant payers. These guidelines outline the requirements and criteria for billing TCM services, including patient eligibility, timeframes for billing, and documentation requirements. Billing rules and requirements may be updated periodically, so it’s crucial to be aware of any changes affecting TCM medical billing.
- Identify Eligible Patients: TCM services are typically available to Medicare beneficiaries and other insurance plans. Ensure that the patient meets the eligibility criteria for TCM, which often includes having moderate or high complexity medical decision-making during the hospital stay and requiring follow-up care within a specific timeframe after discharge.
- Document Patient Consent: Obtain and document the patient’s consent for TCM services. This consent should be obtained during the patient’s hospital stay or upon discharge, and it should cover the specific TCM services that will be provided.
- Timely Billing: Be aware of the specific timeframe for billing TCM services. Medicare, for example, typically requires billing within 30 days of the end of the TCM period.
- Use Correct Codes: Assign the appropriate CPT (Current Procedural Terminology) codes for TCM services based on the specific services provided and the time spent on patient care. The commonly used codes include CPT 99495 and CPT 99496 for face-to-face visits during the TCM period.
- Accurate Documentation: Ensure all relevant documentation is accurate, complete, and supports the services billed. This includes documentation of the patient’s hospital stay, the medical decision-making complexity, the details of the TCM services provided, and the time spent on patient care.
- Coordinate with Care Team: TCM often involves coordination among multiple healthcare providers. Communicate and collaborate with other members of the care team to ensure that all services are appropriately documented and billed.
- Monitor Reimbursement: Keep track of the payments received for TCM services and follow up on any denied claims or underpayments. It’s essential to address any issues promptly to avoid potential revenue loss.
- Seek Expert Assistance: If you find TCM billing complex or challenging, consider consulting with a medical billing specialist or a professional billing service with expertise in transitional care management. They can help you navigate the billing process and maximize your reimbursements.
Ultimately, outsourcing TCM medical billing can be a cost-effective and efficient solution to manage your billing and revenue cycle while allowing staff to focus on delivering high-quality patient care. As with any outsourcing decision, it’s essential to carefully research and choose a reputable billing partner with a proven track record of success in medical billing services.