decisionhealth Newsletters, Part B News - 2022 Issue 5 (May)
Didn’t get discharge data? Sorry, you can’t charge TCM
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Article Overview
This premium article addresses a common billing problem involving transitional care management after an inpatient discharge when the payer cannot verify discharge data. It is relevant to billing staff, coders, and practice managers who need to understand documentation coordination between hospitals, hospitalists, and billing providers, as well as how denials and resubmissions may be affected by missing source records.
Why This Topic Matters
Discharge verification is central to getting transitional care management claims processed, so missing hospital documentation can directly affect reimbursement and claims handling.
What You Will Learn
- Why payer verification of inpatient discharge information matters for transitional care management claims.
- What kinds of coordination issues can occur when discharge records are not yet available.
- What follow-up actions may be considered after a denial related to missing discharge data.
- How resubmission concerns can arise when a denied claim may be treated as a duplicate.
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle personnel
- Practice managers
- Compliance staff
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