As home-based primary care makes a comeback, be sure physicians’ payment for services isn’t obsolete. Many of us are old enough to remember “Marcus Welby, M.D.,” and the doctors on shows like “Little House on the Prairie,” who would visit someone’s home in the event of an emergency, or if someone was homebound. House call ...
Coding 99495 and 99496 takes more effort than deciding whether the patient is seen 7 vs. 14 days after discharge. The CPT® guidelines for transitional care management (TCM) codes 99495 and 99496 seem straightforward, initially, but the details are trickier than is commonly recognized. Here’s what you need to know to report these services appropriately. ...
In CMS
Jul 13th, 2018
The transitional care management initial communication requirement stipulates that to report TCM services (CPT® 99495 and 99496), “An interactive contact must be made with the beneficiary and/or caregiver, as appropriate, within 2 business days following the beneficiary’s discharge to the community setting. The contact may be via telephone, email, or face-to-face.” Source: Medicare Learning Network...
With value-based care and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)/Merit-based Incentive Payment System (MIPS) rollout, primary care practices are taking advantage of initiatives such as the Patient-centered Medical Home Program, accountable care organizations/Medicare Shared Savings Programs (MSSPs), and chronic care management (CCM) to increase revenue and establish the in...
In Billing
Jul 25th, 2016
Medicare allows separate payment under the Medicare Physician Fee Schedule (MPFS) for non-face-to-face care coordination services furnished on or after Jan. 1, 2015, to Medicare beneficiaries with multiple chronic conditions (e.g., diabetes and depression). With only one code describing chronic care management (CCM), coding is straightforward. This may change in 2017. Proposed Changes In the 2017 ...