decisionhealth Newsletters, Part B News - 2013 Issue 3 (March)
Good news — practices reveal CMS, private payers paying some TCM claims
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Article Overview
This article reviews early billing experiences with transitional care management claims across Medicare, Medicare Advantage, and some private payers. It highlights general reasons claims were paid or denied, summarizes CMS updates and open-door guidance, and notes that payer policies and billing conditions can vary. The piece is aimed at practices and coders evaluating whether TCM claims are likely to process and what broad CMS guidance may affect them.
Why This Topic Matters
Practices need to know how new transitional care management claims are being handled in the real world, especially when early denials may be tied to timing, documentation, or payer policy differences. The article helps readers gauge the current coverage environment and understand that CMS guidance and plan-specific rules can affect reimbursement.
Article Sections
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Transitional Care Management
Introduces early payment experiences for transitional care management claims and notes that some claims were approved while others were denied for broad administrative reasons.
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30 days, exactly
Discusses timing-related claim issues and summarizes CMS guidance about the required reporting window for transitional care management claims.
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Discharge comes first
Addresses discharge-related claim processing concerns, along with practice workflow steps some respondents used to support claim submission and appeals.
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TCM FAQ update
Summarizes a CMS FAQ update and related open-door discussion covering general billing questions, non-face-to-face services, and place-of-service concerns.
What You Will Learn
- How early transitional care management claims have been received by different payers
- What broad timing and documentation issues have affected claim processing
- What recent CMS FAQ and open-door guidance addressed at a high level
- How payer policies may vary across Medicare Advantage and private plans
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Primary care practices
- Revenue cycle teams
Codes Discussed
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