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To Bill or Not to Bill - Transitional Care Management Codes and Other Non-Face-to-Face E/M Services: Lessons from the First Year

To Bill or Not to Bill - Transitional Care Management Codes and Other Non-Face-to-Face E/M Services: Lessons from the First Year

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Speaker: Betsy Nicoletti

Length 90-minutes

Betsy NicolettiTCM (Transitional Care Management) codes are a year old but questions about correct coding and documentation linger. Practices are plagued by denials for the wrong date of service and questions about billing for additional E/M services in the TCM period. Some physicians think they can bill TCM for every hospital discharge!

Betsy Nicoletti, founder of and expert on coding and compliance will answer the following questions:

  • What is the correct date and place of service?

  • What needs to be documented in the record?

  • What other services can be reported? What do we do if the patient is readmitted to the hospital?

CMS recently approved paying for care management for patients transitioning from a hospital setting (inpatient) to the patient's home or community setting. Attendees to this practical and timely program will hear about the new covered "Transitional Care Management" codes.

And, there is more news on the horizon. The 2013 Proposed Physician Fee Schedule Rule discussed Medicare's plans for 2015 and coverage of Complex Chronic Care Coordination services. But, practices that intend to provide and be paid for performing these oversight activities will need to prepare in 2014. There are many practice requirements before a group will be eligible to perform these services. CMS has not released the details, but learn what they did say and get a jump on preparing.

This webinar will describe the nuts and bolts about billing for Transitional Care Management codes, what is included and what may be reported separately. Using the codes will require work flow changes: the practice must contact the patient within tight time frames, see the patient, select the correct code based on complexity and then hold the claim for 30 days. This seminar will provide ideas about changes to work flow in a medical practice to bill for these services.

CMS's stated goal is to move from paying for quantity of services to paying for quality. Reimbursing for TCM and paying for Complex Chronic Care Coordination services are two ways of increasing payment for caring for a population of patients. Medical practices that pay attention to the rules can increase their revenue while improving care.

By the end of this session, attendees will learn specifics on the following:

  • Describe the components of the non-face-to-face services

  • Can we bill it to the patient?

  • Might the insurance company pay it?

  • If we report the service, what needs to be documented?

  • Research the payment indicators and RVUs for these services and be certain of Medicare policy

  • Develop a strategy for identifying commercial payer policies and patient due policies for non-face-to-face CPT codes.

Betsy Nicoletti is the co-founder of, a free website devoted to coding, billing, and physician reimbursement. She is the author of The Field Guide to Physician Coding and Auditing Physician Services, published by Greenbranch Publishing. She developed The Accurate Coding System to help doctors get paid for the work they do. As a certified coder, Betsy simplifies complex coding rules for practitioners and engages physicians in a positive and respectful way, which encourages attention and accuracy in their coding. Besides doing auditing and compliance work, she is a speaker, writer and consultant in coding education, billing and accounts receivable management.

Betsy holds a Masters of Science in Organization and Management from Antioch, New England, and has worked in and around physician offices for over 25 years and she's been a certified coder in since 1999. Betsy is a member of the National Speakers Association, the Medical Group Management Association and the Healthcare Financial Management Association.

Betsy was awarded the 2010 QuantiaMD Community Choice Award for Excellence in Knowledge and Sharing Information. She was the only person to win the award who was not an MD, showing the tremendous value the physician community places on her!