for physicians, often resulting in difficul- ties getting paid: Differences between Medicare rules and CPT guidelines led to claims-processing errors, and CMS was tardy in getting instructions out to the physician community. The policy took effect Jan. 1, 2013, but CMS did not release detailed guidance until March 2013 and beyond.
The agency acknowledges its short- falls, saying it made adjustments to its claims-processing systems to streamline the billing requirements for the transi- tional care service. “We believe that with the adjustments that we have made and extra care with billing on behalf of prac- titioners, that the problems that have been encountered will be alleviated,” of- ficials wrote. TMA officials also expressed concern,
however, that the transitional care pay- ment policy does not allow physicians to bill at the time they provide the service. Instead, they have to wait until 30 days after the patient is discharged from in- patient care, which could not only delay payment for services already provided, but also add to administrative burdens when it comes to keeping track of docu- mentation.
TMA advocates that such hassles be avoided as the new chronic care man- agement payment policy is developed. AMA is working with CMS on coding, cost, and payment considerations, and CMS is expected to address coding, prac- tice standards, and payment amounts in rulemaking this year. Meanwhile, to prepare for the new
chronic care management coverage, TMA Payment Advocacy staff recom- mend physicians familiarize themselves with CPT guidelines for the chronic care codes 99487 and 99489. Once CMS guidance is available, doctors should thoroughly review it for any differences between Medicare and CPT rules. Find TMA’s detailed guidance on how to bill for transitional care services online at
www.texmed.org/Transition alCare. And if you’re having payment problems, TMA wants to know. Down- load the TMA Payment Advocacy Depart- ment’s Hassle Factor Log online at www
.texmed.org/hassle, or contact the TMA Knowledge Center at (800) 880-7955.
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