Outpatient Facility Coding Alert - 2016 Issue 18
E/M Services: CMS: You Needn't Hold Transitional Care Management Claims for 30 Days
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Article Overview
This article covers a CMS update on transitional care management under Medicare and how it affects when claims may be submitted. It is relevant for clinicians, coders, billing staff, and practice managers who handle E/M services, post-discharge follow-up, and Medicare claims workflows. The article also summarizes related documentation expectations and references guidance from CMS and a Medicare MAC.
Why This Topic Matters
The policy change affects claim timing, documentation workflow, and reimbursement processing for transitional care management services. Understanding the update helps practices align Medicare billing procedures with current CMS guidance and reduce claim-holding delays.
Article Sections
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Background on Transitional Care Management
Introduces the Medicare transitional care management topic and the billing workflow issue that prompted the update. Provides general context for how these services fit into post-discharge care.
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Submit Claims Right Away
Summarizes the CMS update on claim submission timing for transitional care management services. Discusses the revised approach to reporting the service date and filing claims.
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Fee Schedule Explained Change
Notes the related policy language in the 2016 Physician Fee Schedule Final Rule. Describes the broader regulatory source for the updated claim-submission guidance.
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Keep the Two-Day Window in Mind
Reviews the post-discharge communication timeframe discussed in the article. Focuses on the general timing expectations associated with transitional care management documentation.
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Meet These Documentation Requirements
Outlines the documentation elements cited in the article for transitional care management claims. Also highlights the relationship between documentation and selecting the appropriate service category.
What You Will Learn
- How CMS changed the timing of transitional care management claim submission
- What general documentation elements are associated with transitional care management billing
- Which federal guidance sources and Medicare administrative references are discussed
- How the article frames transitional care management within E/M services and post-discharge follow-up
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Physicians and practitioners
- Revenue cycle teams
Codes Discussed
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