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Coordinate hospital outreach efforts to succeed with TCM services

01/21/2019

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.

Look for motivated managers, ‘secret sauce’ when you outsource your billing

01/21/2019

by: Roy Edroso

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.

HCC fraud case a warning to check risk-adjustment coding on MA patients

01/21/2019

by: Roy Edroso

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.

GAO: New payment rates for Part B lab tests may lead to billions in overpayments

01/21/2019

by: Sarah Gould

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.

TCM utilization growth is impressive; denial rate drop even more so

01/21/2019

by: Roy Edroso

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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