CPO, TCM And CCCC - An Alphabet Soup Of Outpatient Care Management

Event Information
Product Format
Prerecorded Event
Jill M. Young, CPC, CEDC, CIMC
60 Minutes
Product Description

Reporting Complex Chronic Care Coordination codes— know the when, where and how’s

Medicare allows the payment for both Care Plan Over Sight and Transitional care management, in an effort to keep patients healthy and out of the hospital,  other carriers are now following suit. Complex Chronic Care Coordination is the latest of these services that Medicare is now looking at, for payment to physicians for outpatient management of out aging population. Each set of codes is for a different type of care and has its own documentation and billing rules. Many offices have been performing this type of care for their patient but have not been reimbursed for their time.

Join Jill M. Young, CPC, CEDC, CIMC in this 60 minute audio session to get the latest policy guidelines and tips on documentation requirement for correct reimbursement of time. She will shed light on where to watch for Complex Chronic Care Coordination information from Medicare and when will they start paying for these codes.

Topics covered in the session:

  • When, where and how you can start reporting Complex Chronic Care Coordination codes?
  • Dates of service, place of service and other technical information needed to file a complaint payable clean claim
  • Which part of the service can ancillary staff provide and which  parts are providers required to perform
  • Can your Non-Physician Practitioners (NP, PA) assist in these services or can they be the billable provider of record
  • Transitional Care services, what is included and what is separately billable in this 30 days of care (don't miss on payment for billable services)

Key highlights of the session:

  • What is Transitional Care Management and CMS Comments on TCM.
  • Provider Types eligible to bill
  • Documentation Requirements & Guidelines along with Template for TCM Documentation
  • Rules pertaining to Discharging Physician vs Community Physician
  • Who Can Provide Service Elements?
  • Medical Decision Making (MDM) - Moderate Complexity vs High Complexity
  • Multiple TCM Care Codes Submitted for Payment
  • Non-Face-to-Face Services by Clinical Staff
  • Non-Face-to-Face Services by Provider
  • Care Plan Oversight & Other Services Edited Out
  • What date of service do you put on the claim form?
  • Does the performing physician have to be a primary care doctor?
  • Can a Nurse Practitioner or Physician's assistant perform/bill for this care?
  • Does the patient have to be an established patient as CPT®  indicates?
  • What location are allowed for the patient transfer? - from what location(s) to what locations(s)
  • What type of communication is allowed for the 2 day contact with the patient the code mentions?
  • If it takes 3 days to contact the patient does that mean I cannot bill for TCM?
  • What happens if the patient is sick during the 30 day period and they come into the office for care?
  • Who are the patients that a provider can report these codes on - can they be new
  • Communication with the patient - what is required and what is documented
  • Can you bill other E&M codes and CPO codes while billing for these codes ?
  • Areas where CMS & CPT® differ in their policy language
  • Billing a discharge day code and a TCM code, is it allowed ?

Plus, Valuable Insights on :

  • Initial Contact - Interactive contact with the patient or caregiver required
  • Business Days & Medication Reconciliation
  • Face-To-Face Visits
  • Additional reasonable and necessary E/M services
  • Place of Service & Services in the Global Period
  • Patient’s Re-admission, Patient’s Death & Patient Co-Pay
  • Primary Care Exception
  • Recap of Claim Details & Myths

Who should attend: Physicians, Non physician practitioners, Managers, Billers

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About Our Speaker

Jill M. Young - Pulmonology Guidelines Expert

Jill Young, CPC, CEDC, CIMC, is the Principal of Young Medical Consulting, LLC, A company founded 11 years ago to meet the education and compliance needs of physicians and their staff. Jill has over 30 years of medical experience working in all areas of the medical practice including clinical, billing and rounding with physicians. Her comments and opinions can be seen in several publications and also...   More Info
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