Transitional Care Management (TCM) codes - Compliant use

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

Many medical societies pushed for these new reimbursement guidelines implemented in 2013. But there are many questions raised about documentation and utilization rules with them. CMS initially recommended its own G code but when they decided to go with the CPT® code, some of the rationale and logic for the codes were not redefined. You need to make sure you are not limiting yourself because of the G code logic and missing out on opportunities to bill for these services, which is very important for your financial health. For instance, compliant use of the codes based on encounters with the patient is really very important and can affect your revenue. Additionally, you also need to understand when you can bill for other E&M services within the 30 days of the TCM codes, so you won't leave any reimbursement dollars on the table.

Join this educative session presented by expert speaker Jill M. Young, CPC, CEDC, CIMC who will enlighten you on the best sources of information about these new codes; when does the clock start for the timelines mandated by the codes i.e. within 2 days of discharge; understanding CMS definition of business day and why it matters; documentation tips for each code - how they are similar and where they are different.

Here's a look at what the speaker will cover:

  • 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
  • And Much More….

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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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