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Transitional Care Management Top Three Pitfalls for Claim Denial

Transitional Care Management: Top Three Pitfalls for Claim Denial

What? Medicare and Medicaid: Transitional Care Management (TCM)
Who? All specialty physicians caring for high/moderate complexity patients
When? After patient gets discharged from the hospital for follow-up care in your practice
Why? To secure timely follow-up for patients and accurate reimbursement for physicians.

Click here for more specifics about TCM Requirements and difference in physician reimbursement for the same medical complexity.

Three Common Pitfalls

Denials are unfortunately common when it comes to documenting Transitional Care Management claims. In order to assist you in your next steps, please be aware of the following pit falls:

  • Untimely Consultation

TCM claim submission requires synergized and timely documentation from multiple levels of care: starting from the office staff creating initial contact with patients, to clinicians performing the necessary face-to-face visit.

It is important to note the difference in business day (for initial contact) and 30 calendar day to complete all requirements. There is also a required distinction for when moderate and high complexity patients are to be seen.

  • Inaccurate Documentation

Something as trivial as the wrong date or CPT code reported may be enough to prompt a denial.

  • Unperformed Clinical Requirements

Medicare and Medicaid not only require services be performed at a timely manner, but certain services must be performed in both face-to-face and non face-to-face visits.

The DocCharge Solution
Effectively Address these Pitfalls by downloading our TCM question guide to learn more.