Transitional Care Management (TCM) Services
There is a lot of confusion surrounding reporting for transitional care management (TCM) services. CPT offers the following options to report TCM services:n
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- 99495 – Transitional Care Management services with the following required elements: communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge; medical decision making of at least moderate complexity during the service period; face-to-face visit, within 14 calendar days of discharge
- 99496 – Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge; medical decision making of high complexity during the service period; face-to-face visit, within 7 calendar days of discharge
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nWhen billing for TCM services, the rendering provider must assume all responsibility for the patient’s care post-discharge leaving no gap in care. The rendering provider must deliver care during the patient’s transition back home following discharge. The patient must return to his/her residence following discharge. Authorized community settings include: home, domiciliary, rest home, assisted living facility. TCM cannot be reported if a patient is discharged from one inpatient facility to another inpatient facility, such as a skilled nursing facility. Each patient must meet the complexity requirements for each CPT code (i.e. moderate for 99495 and high for 99496).nnCMS allows TCM services to be reported in the following discharge settings:n
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- Inpatient acute care hospital
- Inpatient psychiatric hospital
- Long-term care hospital
- Skilled nursing facility
- Inpatient rehabilitation facility
- Hospital outpatient observation or partial hospitalization
- Partial hospitalization at a community mental health center
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On Nov. 2, CMS 
All of us at Welter Healthcare Partners, would like to wish our clients, families and friends a Happy Thanksgiving! We are grateful for the relationships we have formed and for your continued to support of Welter Healthcare Partners. In observance of the holiday, we will be closed on 
Decision-making in its most basic form is the act of choosing between two or more courses of action. Each and every person in the world is faced with the decision-making process on a daily basis – whether it’s trivial things like deciding what is for dinner or which route to take to work or more serious life-changing decisions like what your next career move should be or which home is the best long-term investment for your family. To be effective in the decision-making process, it is imperative to avoid impulsive behavior and really think each scenario through. This can be done via pros/cons list, intuition, and/or reasoning. All methods have both advantages and disadvantages. Regardless of the method(s) chosen, avoid the following problems that can hinder effective decision-making: not having enough information to see the big picture, having too much information and going down the path of “analysis paralysis”, having too many hands in the pot, vested interests, emotional attachments, and having no emotional attachment. Being effective in the decision-making process is key to future success!
On November 2, CMS issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after 
Unfortunately, many healthcare providers are missing out on things like electronic billing, email capture.nnA new survey by the Medical Group Management Association suggests providers, especially hospitals, are missing out on key areas to improve when it comes to patient billing, payments and satisfaction.nnThe Digital Payments Progress report, a product of a partnership with medical claims management company Navicure, is a national survey conducted among MGMA member organization this past May.nnThe report shows that physician practices seem to have the advantage when it comes to billing and payments. For instance, 79 percent of ambulatory organization respondents can generate a cost estimate upon request, while only 69 percent of hospital respondents can do so.nnAlso, 64 percent of group practice respondents reported patients are comfortable sharing their email address, while only 56 percent of hospital respondents had that perception.n“In actuality, 79 percent of patients report feeling comfortable providing their email address. This represents an opportunity to leverage email addresses to deliver bills electronically, saving the industry millions of dollars in cost, environmental waste and days in A/R,” the report said.nnThere are also other key areas where all providers could be doing a better job of playing to the needs and wants of consumers. Despite a majority of patients’ preference for electronic billing, 52 percent specifically, 77 percent of respondents still send paper bills. A similar study conducted in January by Navicure and Himss Analytics showed the same trend, with 52 percent of patients preferring electronic billing but 89 percent of providers saying they still used regular mail.nnThe HIMSS/Navicure study also showed keeping a credit card on file is something that 78 percent of patients approve of for small charges totaling less than $200 but only 20 percent of providers used this method.nnThe Progress Report echoed this notion, with results showing CCOF would be highly beneficial to revenue cycle management, and ultimately a provider’s bottom line. It helped reduce patient bad debt/write off, according to 36 percent of respondents, and 34 percent said it cut days in patient A/R and cost of collections, the report said.nnIn an age of consumerism, where patients are paying more out-of-pocket costs and shopping around for providers and services, practices and hospitals alike would do well to pay attention to these trends among patients, who now act more like retail consumers who go where their needs and preferences are met. Consumers have voiced a willingness to switch providers in order to have services like telehealth available to them. Chances are, as they become even more discerning and demanding, something seemingly small like electronic billing could prove pivotal when it comes to keeping patients’ business.nnThis 
MI code updatesnnThe list of ICD-10 code updates is extensive and Myocardial Infarctions got a makeover with this year’s revision. Code category I21 has been renamed from “ST elevation and non-ST elevation myocardial infarction” to “Acute myocardial infarction”. Additional specificity options now include type 1, type 2, and other MI types. Providers will need to specify in clinical documentation the type of MI the patient experienced. STEMI codes (I21.0 and I21.1) are now defined as Type 1 MIs. New codes I21.A1 – MI type 2 and I21.A9 – other MI type are also important and notable additions.
WASHINGTON — President Trump reversed course Wednesday and threw cold water on a new bipartisan congressional health care plan designed to maintain subsidies for health insurance exchanges, thereby temporarily propping up the Affordable Care Act.nnA day after signaling support for the plan developed by Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., Trump tweeted Wednesday that the deal might benefit insurance companies too much.nnAlexander, in a series of tweets Wednesday, indicated the deal may still have a chance. After getting a phone call from Trump, he wrote that he agrees the subsidies should benefit consumers and not insurers.nn”The Alexander-Murray agreement has strong language to do that, and I will work with the president to see if we can make it even stronger,” Alexander tweeted.nnMurray and Alexander have been drafting a bill for several months to boost the insurance marketplace, but the effort took on new urgency last week when Trump announced he would no longer fund the subsidies without congressional action.nnWhile House and Senate Democratic leaders said they support the compromise, Republican leaders aren’t eager to bring it to the floor for a vote.nnHouse Speaker Paul Ryan’s press secretary, Doug Andres, said in a Wednesday statement, “The speaker does not see anything that changes his view that the Senate should keep its focus on repeal and replace of Obamacare.”nnOn Tuesday, Senate Majority Leader Mitch McConnell, R-Ky., told reporters, “We haven’t had a chance to think about the way forward yet.”nnRegardless of Trump’s position, the deal’s Senate supporters will pursue an even number of bipartisan cosponsors to help build pressure for a vote, Senate Minority Leader Chuck Schumer of New York told reporters Wednesday.nn”I spoke to Senator Alexander this morning, and I encouraged him, ‘Let’s go forward, period,’ and he’s game,” Schumer said. Once cosponsors are lined up, Schumer said he’ll ask McConnell for a vote.nn”If that happened, I would be quite certain it would pass…and then there would be pressure on the House,” he said. “If the president will come out strongly for the bill and stick to that, that will help us get it through the House.”nnAlexander also said Trump and the House will have to consider the agreement once more senators are on board.n
Physician practices may begin data collection as late as December 31 and still avoid the negative payment adjustment.nnOctober 2, 2017, marked practices’ deadline to begin collecting data for the Centers for Medicare & Medicaid Services’ (CMS) “pick your pace” option two under the merit-based incentive-payment system (MIPS) track of the Medicare Access and CHIP Reauthorization Act (MACRA).nnFor this transition year of the 
As most medical practices are aware, not all cases are easy to navigate using the latest medical standards. The information below highlights a complicated cardio surgical case with an detailed cardio case, correct CPT and ICD-10 codes. Do you have a complicated surgery case need help with coding? Welter Healthcare Partners would love to help! please upload the operative note by clicking on the link below. Remember to remove ALL patient protected health information and organization identifiers. Welter Healthcare Partners will not use any medical records submitted in which PHI is not removed and protected. Click Here To Submit Redacted Surgery Case Study. 
With the implementation of QPP, the deadline for submitting 2017 performance data is approaching fast! Eligible providers can submit performance data for dates of service starting on January 1, 2017 – October 2, 2017. Data submission to CMS must be done by March 31, 2018.nnIf your practice chooses not to submit data for 2017 reporting, then you will receive a negative 4% payment adjustment. If your practice submits the minimum data required for 2017 reporting, you can avoid the negative adjustment and receive a neutral adjustment. If your practice submits partial data required for 2017, which is 90 days of 2017 data, you will receive either a neutral or positive adjustment depending on your performance. If your practice submits a full year of data for 2017, you may receive up to a 4% positive payment adjustment, again depending on your performance. The first payment adjustments based on performance go into effect on January 1, 2019.n
2018 ICD-10 updates will soon go into effect on October 1st. These changes will impact encounters for dates of service October 1, 2017 through September 30, 2018. It is imperative that your organization has up-to-date coding resources and a keen understanding of the changes that will impact your reimbursement!nnThis year’s ICD-10 updates include 363 new codes, 142 deleted codes, and 250 code revisions.nnHere are notable highlights of the 2018 updates:n
nnNo matter how much we plan things out and hope for the best, there will inevitably, always be something that we didn’t think of or plan for. That is why prioritizing, planning, and time management are such important skills to have in today’s job market. When you know what needs to be done and the deadline, you can be ready for anything that may come your way! Expect the Unexpected! You can’t see the future but if you are aware of your surroundings and potential obstacles, you can anticipate a need before it is asked of you. There is no room for procrastination in the ladder to success!
GOP Senators are working quickly in an effort to garner votes to replace the ACA (Affordable Care Act). Check out the most important things to note about this replacement effort, below.nnRepublican efforts in Congress to “repeal and replace” the federal Affordable Care Act are back from the dead. Again.nnWhile the chances for this last-ditch measure appear iffy, many GOP senators are rallying around a proposal by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), along with Sens. Dean Heller (R-Nev.) and Ron Johnson (R-Wis.)nnThey are racing the clock to round up the needed 50 votes — and there are 52 Senate Republicans.nnAn earlier attempt to replace the ACA this summer fell just one vote short when Sens. Susan Collins (R-Maine), Lisa Murkowski (R-Alaska) and John McCain (R-Ariz.) voted against it. The latest push is setting off a massive guessing game on Capitol Hill about where the GOP can pick up the needed vote.n
Effective for claims with dates of service on or after Oct. 1, 2017, UnitedHealthcare will reimburse the appropriate evaluation and management (E/M) procedure code which describes the office visit, hospital care, nursing facility care, home service or domiciliary/rest home care reported in lieu of a consultation services procedure code. This notification will be the first of several communications to clarify this change in reimbursement strategy supporting our commitment to the Triple Aim of improving health care services, health outcomes and overall cost of care.nnUnitedHealthcare will align with the Centers for Medicare & Medicaid Services (CMS) and no longer reimburse consultation services represented by CPT codes 99241-99245 and 99251-99255. At the time of the original CMS decision to no longer recognize these consultation services procedure codes, UnitedHealthcare began pursuit of data analysis and trending to better understand the use of consultation services codes as reported in the treatment of our commercial members. Similar to CMS’s findings, our extensive data analysis has revealed misuse of consultation services codes for this population.nnThe current Relative Value Unit (RVU) assignments reflect numerous changes made during recent years to both E/M codes and other surgical services creating an overall budget neutral experience supporting this strategy as a more accurate reflection of services rendered.n
Welter Healthcare Partners is excited to present our monthly Code Spotlight! Each month, Welter Healthcare Partners will spotlight a unique CPT or ICD-10 code to profile and discuss practice applications of the code, as well as pertinent guideline reminders.nnM48.062 – Spinal Stenosis, lumbar region, with neurogenic claudicationnThe list of ICD-10 code updates is extensive and lumbar spinal stenosis got a makeover with this year’s revision. The previous code M48.06 – Spinal stenosis, lumbar region will no longer be valid as of October 1st. There are now two new code options to replace the old code. These options now include specificity for neurogenic claudication. Spine surgeons and coders will be excited to finally have a code to capture this level of specificity!nnIt is important for coders to understand the clinical definition of neurogenic claudication. “Neurogenic claudication is the medical term used to describe the symptom of pain induced by walking,” according to spinal-healthcare.com, which goes on to call the condition “a hallmark symptom of lumbar stenosis.” Clinical documentation should include indications of trouble walking in the operative notes. If there is no indication of ambulatory issues or other signs of neurogenic claudication, you’ll assign the code for lumbar stenosis without neurogenic claudication; if the note describes the patient as having ambulatory issues due to stenosis, this could indicate claudication, in which case you’ll need to assign M48.062.
As part of the new coding format for our newsletter, Welter Healthcare Partners is excited to offer you a new surgery coding series in which we want to help you! The 2nd week of every month we will highlight a complicated surgical case. This week we are highlighting a general surgery case. We want to hear from you! If you have a complicated surgery case and need help with coding, please upload the operative note by clicking on the link below. Remember to remove ALL patient protected health information and organization identifiers. Welter Healthcare Partners will not use any medical records submitted in which PHI is not removed and protected. Click Here To Submit Redacted Surgery Case Study. 
As a result of the many provisions of the Affordable Care Act (ACA), the CMS Innovation Center (CMMI) was created to promote quality healthcare, stronger health outcomes, and encourage fiscal responsibility. CMMI acts as the facilitator for designing the most efficient payment methodology for reimbursing healthcare providers based on value rather than volume. CMMI also provides a platform for doctors, stakeholders, and other health care partners to participate in a collaborative process for generating the ultimate pay-for-performance model.nnCMMI is responsible for the implementation and oversight of Quality Payment Program (QPP), which aligns all other incentive programs such as Meaningful Use, Value Based Payment Modifier, and PQRS. Practices will begin to see the financial impact of QPP starting in 2018. Upcoming CMMI initiatives include:n