Wiki Transitional Care Management (TCM)

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williamsontnt@cfl.rr.com

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We have been having issues with Humana paying our claims when we bill out a 99495 or 99496.

For example, a patient is discharged from the hospital on January 1st and came in to see his primary care physician for a face-to-face on January 6, would it would be proper to bill a 99496 with a date of service of January 6, understanding that any additional services that pertain to this TCM could not be billed within the 30 days of discharge.

All other payers are paying, including Medicare, except for Humana. We recently had a conference call with some Humana coders who stated that we are doing it wrong and are confused as to how this should be billed. Their explanation to my example was this: If the patient was seen on January 6 for a face-to-face followup from their discharge on January 1, then we have to bill the 99496 with a date of service of January 30 because this would be the last day of TCM.

Does anyone have any insight to this issue because it seems to me that billing a date of service that is not the date that the patient was seen is wrong. Any help in this issue would be very much appreciated.
 
TCM Question

Per TCM guidelines the date of service on the claim must be the 30th day from the date of discharge from the hospital or rehab facility. So if the patient is discharged on January 1, that would be the first day. You would then go out 29 more days and the date of service would be January 30.

Here is the Medicare Q&A on TCM and the MLN bulletin with all of the guidelines for billing TCM. Hop this helps.

http://www.cms.gov/Medicare/Medicar...ment/PhysicianFeeSched/Downloads/FAQ-tcms.pdf

http://www.cms.gov/Outreach-and-Edu...-Management-Services-Fact-Sheet-ICN908628.pdf
 
kt is correct. TCM "covers" the pt for a 30 day period. That period "ends" on the 30th day. You have to hold the claim and change the DOS to the 30th day and not actually bill the claim until the 30th day after d/c.The dr can bill TCM only if the pt needs assistance "transitioning" back to their home from an inpatient (not obs) or SNF stay. There are many documentations points that the dr/staff has to chart in the record as well. view the links that kt posted. They explain it all very well.
 
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