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Stay dedicated to your transitional care management (TCM) program, particularly in the ongoing effort to wrap in eligible patients, and you stand to gain revenue and get up leg up in the larger shift to value-based care.

If you’re thinking of transitioning your billing functions from in-house to outsourced, check out a few things besides the basic bottom-line numbers to make sure the relationship will be a happy one.

As the Department of Justice (DOJ) joins a large fraud case against providers that hinges on risk-adjustment coding under Medicare Advantage, make sure your coding is not suffering from similar issues that could make your practice vulnerable.

Medicare’s new method of calculating payment rates for laboratory tests, intended to reduce Medicare spending by $360 million in the first year, could cost the agency billions in overpayments, according to a recent report from the U.S. Government Accountability Office.


The specialties that are using transitional care management (TCM) codes 99495 and 99496 the most haven’t changed much since the codes were first paid by Medicare in 2013; what has changed is the rate of utilization — and, even more spectacularly, the rate of denial.\


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