KHerron
New
- Messages
- 5
- Location
- Grovetown, GA
I work for a large group family medicine practice and we bill a lot of TCMs for our patients. We get quite a few denials for no qualifying service. We are discussing implementing a 10 day hold on our claims in order to give the inpatient claims time to process. However, I am also hoping that someone with a lot of experience in billing and coding TCMs can assist me in how we can determine from a discharge summary that the patient would have an inpatient claim. Even when patient is seen in the ER or has a day surgery, the note will state admit and discharge dates. The TCM department we have currently only looks for admit and discharge on the summary to determine if a TCM is eligible to be billed, but I believe there has to be more to it. I have looked at the MLN and it does not give much detail as I would like. We have had some TCMs pay when patient was only in the hospital overnight so it does not appear that the 2 midnight rule is the determining factor. We have not had much luck in getting information from the hospitals in providing information on if an inpatient claim was billed and paid. Posting in the inpatient facilities thread to see if someone with inpatient experience might be able to shed light on when inpatient claim would be filed vs outpatient claims. If anyone has some guidance they could provide, it would be greatly appreciated!