Transitional care management (TCM) services are intended to help a patient transition, upon discharge, from an inpatient setting back to their home setting. Here are several areas you will want to look into for proper coding, documentation, and billing guideline use:
Who are the eligible providers that can perform TCM services?
Who can perform the non-face-to-face vs. face-to-face portion of the TCM service?
What types of locations are approved for post-discharge TCM services?
Molina Healthcare, Inc. (Molina) and its previously owned subsidiary, Pathways of Massachusetts (Pathways), have agreed to pay $4.625 million to resolve allegations that it violated the False Claims Act by submitting reimbursement claims while violating several regulations related to the licensure and supervision of staff.