Transitional Care Management: Reimbursement of Non-Face-To-Face Services

March 5, 2013
92 Views

Image

Image

As of January 1, 2013, the Medicare Physician Fee Schedule includes reimbursement for transitional care management (TCM) services from the hospital to the community setting.  The two relevant codes are 99495 and 99496 and apply to physicians and other qualified non-physician professionals.  The goal of this investment is to generate savings from a reduction in the number of re-admissions.

While this new approach to reimbursing for care is truly welcome, the inclusion of non-face-to-face care management services is an opportunity to leverage enterprise portals and social technologies to facilitate these processes.  The following services are required be provided unless they have been determined to not be medically necessary:

Performed by a qualified professional:  obtain and review discharge information; review need for, or follow-up on, pending diagnostic tests and treatments; interact with other providers involved in patient’s care; educate patient, family, guardian, and/or caregiver; arrange for needed community resources.

Performed by clinical staff or case manager under direction of qualified professional:   communicate with home health agencies and other community services utilized by patient; educate patient and/or family/caretaker regarding self-management, independent living, and activities of daily living; assess and support treatment regimen adherence and medication management; identify available community and health resources; facilitate access to necessary care and services.

Now is the time for innovative providers to develop new processes and create strategies for leveraging technologies to support delivery of these important and reimbursable services.

For a detailed summary of the billing requirements for TCM, visit the PYA Healthcare Blog and CMS FAQs.

You may be interested

Healthcare Tech Advances That All Clinics Should Use
Medical Devices
461 views
Medical Devices
461 views

Healthcare Tech Advances That All Clinics Should Use

Dennis Hung - August 12, 2017

Healthcare will always be important to employees and the government since the issues surrounding healthcare are inherently ethical and moral…

Balancing Smart Data With Cybersecurity for Hospitals
Hospital Administration
456 views
Hospital Administration
456 views

Balancing Smart Data With Cybersecurity for Hospitals

Kayla Matthews - August 11, 2017

It should come as no surprise that your discussions and interactions with physicians and health professionals influence diagnoses, prescriptions, visit…

4 Ways to Halt Testosterone Problems After 40
Wellness
471 views
Wellness
471 views

4 Ways to Halt Testosterone Problems After 40

JohnHenning - August 10, 2017

Among men of all ages, testosterone is an important hormone for regulating health. Men over the age of 65 tend…