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Billing 99496

William Ivan Posted Wed 17th of September, 2014 09:49:14 AM

If a different provider billed 99496 and the claim was processed first, how should my provider then bill?

SuperCoder Answered Wed 17th of September, 2014 11:31:14 AM

Thank you for your question.

Please see Medicares response to paying TCM claims by multiple providers below:

Medicare will only pay the first eligible claim submitted during the 30 day period that commences with the day of discharge. Other practitioners may continue to report other reasonable and necessary services, including other E/M services, to beneficiaries during those 30 days.

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/FAQ-TCMS.pdf

William Ivan Posted Wed 17th of September, 2014 12:41:19 PM

what if the doctor sees the patient within 7 days but then bills on 30th day but ultimately a different provider gets processed first. How should we then bill? I understand you state that we may continue to report other reasonable and necessary services, including other E/M services. But if the reason the patient was seen was for the transitional care, then it gets denied because a different practitoioner processed first, can we then rebill it as an e/m visit

SuperCoder Answered Thu 18th of September, 2014 07:57:42 AM

If the service is TCM, then the TCM guidelines above need to be followed. Even if the claim is billed out in time, the claim that is received first is processed first. If the patient is seen for and E&M visit, then that may be billed out, however, it must contain the appropriate criteria and documentation to support a visit other than TCM.

William Ivan Posted Thu 18th of September, 2014 09:18:31 AM

What you are saying is if I bill a TCM visit and a different provider also bills a TCM visit but their claim gets processed first, mine will be simply denied and will be a loss?

SuperCoder Answered Thu 18th of September, 2014 10:07:54 AM

Yes, according to Medicare Guidelines.

"Medicare will only pay one physician or qualified
practitioner for TCM services per beneficiary per 30 day period following a discharge. If more than one practitioner reports TCM services for a beneficiary, how will Medicare determine which practitioner to pay?"

"Medicare will only pay the first eligible claim submitted during the 30 day period that commences with the day of discharge. Other practitioners may continue to report other reasonable and necessary services, including other E/M services, to beneficiaries during those 30 days"

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/FAQ-TCMS.pdf

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