Wiki Transitional Care Management Services

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Millface

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I have several physicians asking about the TCM services and the most frequently asked question is if case management can proivde the 2 business day contact with the beneficiary. My thought is no as services need to be provided by clincial staff under direct supervision of the physician.
Any thoughts or insight would be very much appreciated!
Thanks,
Tara Miller, CPC
Indiana University Health
765-448-8152
tmille19@iuhealth.org
 
Per a webinar from Kareo and their Q & A after:

Q-As long as a staff member communicates withe tha patient in the 2 day window is that acceptable?
A-Right. Somone from the practice needs to contact the patient or caregiver but it doesn't have to be the physician.

So per this I take it that someone from the actual PCP or patients provider's office needs to do the 2 day call.
 
Thanks Brittany-
We were reading the guidelines the same way-someone from the patient's providers office needs to do the call not the case management department at the hospital-I just wanted a second opinion for some reason our case management department is insisting their follow up phone call counts as part of the 2 day contact where as my argument is direct supervision of the provider (not to mention hospital case management versus physician office).
 
Tara,
Think of it this way, it is your provider charging for the TCM, therefore all requirements for the service must be met by your provider, and his office. This can be face to face or it can be via a phone call but it must be the physician or qualified person under his/her employ
 
The following excerpt is from the June 2013 MLN Fact sheet. From this it seems to me that "anyone" in the office can NOT make this contact but only those listed...

The following health care professionals may furnish TCM services:

■Physicians (any specialty); and
■The following non-physician practitioners (NPP) who are legally authorized and qualified to provide the services in the State in which they are furnished:
•Certified nurse-midwives;
•Clinical nurse specialists;
•Nurse practitioners; and
•Physician assistants.

When “you� is used in this publication, we are referring to these health care professionals.

That is the information I have been passing on to my providers as it seems pretty clearly delineated in the fact sheet to me. :)
 
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