Medicare offers some relief on transitional care management claims

Another month, another set of Medicare fixes aimed at helping physicians submit and receive reimbursement for transitional care management (TCM) claims.

During an Aug. 27 conference call with physicians, nurses, and allied health professionals, Centers for Medicare & Medicaid Services (CMS) staff said that the agency is aware that physicians are continuing to have trouble getting paid for TCM claims and Medicare contractors have made adjustments to their claims edits to address the issue.

CMS has put that acknowledgement in writing in the form of a new question and answer added to its frequently asked questions about TCM.

In response to the question, “What should practitioners do if claims for appropriately furnished Transitional Care Management (TCM) have been rejected or denied by Medicare,” CMS said that many physicians make mistakes on their claims and repeated the main requirements for these types of claims:

    •    the discharge that initiated TCM occurred on or after Jan. 1, 2013
    •    the TCM service began with a qualified discharge from a facility
    •    the date of service on the claim is the 30th day of the TCM service period (i.e. the 29th day after the date of discharge)

The agency then added, "We also have made some adjustments to our claims processing systems to better accommodate the unique billing requirements of this new, 30-day service. We believe that with the adjustments that we have made and extra care with billing on behalf of practitioners, that the problems that have been encountered will be alleviated."

If you verify that all requirements for furnishing the service have been met and the claim is still unpaid, CMS is encouraging you to re-submit it. For more resources about billing TCM services, see the Getting Paid blog post from July 31, 2013, detailing the last batch of TCM assistance.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians