decisionhealth Newsletters, Part B News - 2015 Issue 5 (May)
New CMS guidance: Learn when same-month billing for CCM/TCM allowed
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Article Overview
This article explains recent CMS guidance affecting Medicare billing for chronic care management and transitional care management, including timing, initiating visits, place-of-service reporting, and related claim-processing issues. It is intended for physicians, billing staff, coders, practice managers, and consultants who need to understand policy clarifications from CMS FAQs and MLN materials without missing claim requirements or denial risks.
Why This Topic Matters
The guidance addresses billing timing and documentation issues that can affect whether CCM and TCM claims are payable in the same month. It also clarifies related operational points that may influence compliance, claim submission, and payment outcomes for practices furnishing these services.
Article Sections
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CMS guidance on CCM and TCM billing timing
Overview of the Medicare policy update and the billing timing issues it addresses for chronic care management and transitional care management.
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Billing denials and claim-processing issues
Discussion of how claims may be affected by sequencing, documentation, and contractor review when these services are billed.
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Face-to-face initiation requirements
Summary of CMS clarification regarding the initiating visit for chronic care management and related open questions discussed by participants.
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Additional CCM clarification from the CMS call and FAQ
Other policy points discussed in the CMS guidance, including service location, contracted support, and time-counting considerations.
What You Will Learn
- How CMS guidance affects the timing of chronic care management and transitional care management billing
- What types of policy clarifications CMS provided in the CCM FAQ and MLN materials
- Which operational considerations practices should review when submitting CCM claims
- What related Medicare billing topics were discussed during the CMS open door call
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Practice managers
- Compliance professionals
- Revenue cycle consultants
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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