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Hi Betsy. I am requesting the E/M utilization data of Primary care and internal medicine clinicians as well as nurse practitioners to compare their profile with one another and the CMS norm.
Please can you clarify that if the patient has been on home health within 60 days that the physician can not bill TCM.
If you read through the comments you will find the answer
We have been told by Palmetto that even though we submitted our discharge code, they will not consider payment for TCM until the hospital submits their discharge. I can’t find this anywhere in the regulations. They (Palmetto) told us we had to wait another 20 days. Is this for real?
I haven’t seen this in CMS rules.
Doesn’t seem right to me but Contractors can set this type of rule.
Is it acceptable for your TCM visit to be conducted at the patients home? what about assisted living facilities?
Yes, the face-to-face required service may be performed in the patient’s home or an assisted living facility. It may not be performed in a SNF or long term care facility.
Do you have statistics outside of CMS on the average percentages of levels of office visits for primary care? If not, what would you say to the comment that “Level 4’s are high in the CMS statistic because of the age group that CMS is tracking”. Also, can I assume that mid-level providers are included in the CMS statistic?
The only statistics I have are from CMS. MGMA used to have survey data, but I haven’t seen that in a long time. CMS tracks separate frequency data for each specialty, and puts all NPs, PAs, etc into one group, regardless of the specialty in which they work. While I think that older patients tend to have chronic problems, many patients under 65 have multiple chronic problems, as well.
How many times a year can advanced directive be billed for?
I have a question regarding when you start counting the total time for prolonged services. Example…records reviewed today (related to a recent visit), but doctor can’t call patient until tomorrow. Doctor spends total of 2hrs. Does he count the total time over the span of 2 days? Thank you for your help.
No, there is no provision for adding times over calendar days.
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