Wiki ccm/cpo and tcm

[1christinepeters]

last November we were presented with the 2020 changes and the ability to bill CCM, CCM AND TCM in the same month. Where can I get specifice information on billing cpo ccm in the same month. I had a hand out from my local chapter that someone put together, but i need specifics to send with my appeal. Medicare stating that it's not allowed and they have an 'inter-office publication that is private and I may not view it'. I know it's in the federal registrar, is it anywhere else? Please help.

 

[CAADM]

it's my understanding when we were doing it... tcm takes over the billable time for ccm. tcm is billed for the 30 days after discharge. In order to bill the ccm also, you would have to have the ccm time met before the patient was admitted to the hosp.
as an example, if the patient is admitted on the 15th of the month, your ccm time would have to be met between the dates 1st thru 14th. if you didnt have at least 20 mintues of ccm time met, you cannot bill ccm, you can only bill tcm at that point since the minimum of 20 minutes ccm was not met. so the same for then for the next month in this scenario, tcm is 30 days, so your tcm will end on the 15 of the next month. ccm can then take over and billable if you have your documented time minimum time of 20 minutes

 

[CAADM]

here is some guidance on CPO:
Both CCM and CPO can be provided by non-physician care teams. However, the CPO care team is much more narrowly defined and has to be a very integral part of the physician practice. Most of the time spent on CPO is physician time.
Home Health CPO
Non-physician practitioners can perform CPO only if the physician signing the plan of care provides regular ongoing care under the same plan of care as does the billing for CPO and either:
the physician and NPP are part of the same group practice; or If the NPP is a nurse practitioner or clinical nurse specialist, the physician signing the plan of care also has a collaborative agreement with the NPP; or If the NPP is a physician assistant, the physician signing the plan of care is also the physician who provides general supervision of physician assistant services for the practice.
Billing may be made for care plan oversight services furnished by an NPP when: The NPP providing the care plan oversight has seen and examined the patient; The NPP providing care plan oversight is not functioning as a consultant whose participation is limited to a single medical condition rather than multidisciplinary coordination of care; and The NPP providing care plan oversight integrates his or her care with that of the physician who signed the plan of care. NPPs may not certify the beneficiary for home health care.
Hospice CPO
The attending physician or nurse practitioner (who has been designated as the attending physician) may bill for hospice CPO when they are acting as an “attending physician”. An “attending physician” is one who has been identified by the individual, at the time he/she elects hospice coverage, as having the most significant role in the determination and delivery of their medical care. They are not employed nor paid by the hospice. The care plan oversight services are billed using Form CMS-1500 or electronic equivalent.