Resolved Transitional Care Management

[JuliaM_43376]

I have exhausted my resources trying to find the answer on my own. Can we bill TCM if the patient or caregiver contacts us before we can contact them? Can it be patient or caregiver initiated or does it have to be provider initiated?

 

[Darcy]

No, TCM billing specifically requires the provider to initiate contact within two business days of the patient's discharge

Here's the breakdown:

• Provider Initiation: You, the healthcare provider, must reach out to the patient or caregiver first.
• Patient/Caregiver Contact: While the patient or caregiver can certainly contact you before you reach out, it doesn't fulfill the requirement for TCM billing.

So, even if a patient or caregiver is proactive, TCM billing hinges on the provider initiating contact within the timeframe.

 

[BadrinathP_78365]

You can definitely bill for TCM if the patient or caregiver contacts you first. The key is that you have to be the one managing the care and coordinating follow-ups. So, if they reach out and you handle their needs, you can bill for it.