We were conducting transitions of care visits before the TCM codes became effective January 1, 2013. Fortunately, we only had to make some minor tweaks to our system to fulfill all the requirements of a documented phone call within 2 business days of discharge and seeing the patient within 7 days (99496 – high complexity) or 14 days (99495 – moderate complexity) of discharge. Did others have trouble getting all these steps in place? It’s not easy, that’s for sure!
Do you think these codes are tricky to use compared to other billing models discussed in the reimbursement chapter of the Building a Successful Ambulatory Care Practice book? I think so because of all the little caveats.
Is anyone having trouble getting their visits reimbursed by carriers? Unfortunately, during our quarterly meeting with the billing department, we were told our TCM visits were not getting reimbursed. Good news for us – I think this one is a quick fix (this time!). The one detail that got us: dropping the bill on the 30th day after the discharge date. We thought we had this built into our process but our staff is so used to billing the visit on the actual date of service that in the beginning they continued to bill for that date of service, meaning within the 7 or 14 day window, and not day 30. When the date was entered correctly (30 days after discharge) we have shown successful reimbursements. So what if that 30th day is on a Saturday or a Sunday when your clinic is closed? That’s okay; you just enter it for the 30th day whenever you place the bill.
Key lesson here—always have a system in place to close the loop and make sure your services are actually getting paid. Have a billing representative on your team to watch out for the new codes, work the claim to figure out the issue and be able to rebill if appropriate! We are in the process of rebilling so keep your fingers crossed!
What issues have you faced regarding the new TCM codes? We would love to hear what others have come across and how you have overcome any obstacles.