Are You Missing TCM Revenue After Hospital Discharges? A Primary Care Billing Guide

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A patient is discharged from the hospital, returns to the primary care practice, and the care team spends time reviewing the discharge summary, reconciling medications, coordinating follow-up, answering questions, and managing the next steps. Then the practice bills a regular office visit. That is where some primary care practices may be leaving legitimate TCM revenue unrecognized. Transitional Care Management (TCM) is designed to account for the work involved in managing a patient's transition from an inpatient setting back to the community. Medicare's TCM framework includes communication after discharge, medication reconciliation and management, care coordination, and a required face-to-face visit. For practices handling a high number of hospital discharges, the financial issue is not simply whether the practice knows about CPT 99495 and 99496. The bigger issue is whether the practice has a reliable process for identifying eligible patients, completing the required steps on t...
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Getting Paid for Telehealth Physical Therapy

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Basics of Telehealth Physical Therapy

Medicare covers three types of telehealth physical therapy services i.e., telehealth services, e-visits, and virtual check-ins. But physical therapist still needs to follow a few basic practices for getting paid for telehealth physical therapy, let’s discuss them. During the c, the federal government has broadened access to telehealth services including physical therapy. With revised billing guidelines, all beneficiaries can now connect with their healthcare providers online, and providers will get the same reimbursement for these services as they would for in-person sessions.

Verification of Identity

Given that in the telehealth clinical setting, the beneficiary and therapist are not in the same location and may not have established a prior in-person relationship, it is critical, at least initially, that the identities of the physical therapy providers and beneficiaries be verified. Photo identification is recommended for both the beneficiary and all parties who may be involved in the delivery of care to the beneficiary. The photo identification, at minimum, should include the name of the individual; however, personal information such as address or driver’s license number. 

Informed Consent 

Just as PTs must follow state law requirements and professional best practices for acquiring informed consent for in-person encounters, the same requirements should be followed for the delivery of physical therapy services via telehealth technologies. Given the unique nature of the provision of services through telehealth, there are some special considerations including: 

  • Consent to be photographed, recorded, or videotaped and consent to the storage of the encounter data, if applicable. Disclosure should be made as to how long data will be stored. 
  • Consent procedures should include a hold harmless clause for medical or other information lost because of technology failures. Beneficiaries should be informed of the possibility of failure of the technologies used to provide telehealth services.

Standards of Care 

It is the responsibility of the PT to ensure the standard of care required both professionally and legally per the Practice Act is met. As such, it is incumbent upon the PT to determine which beneficiaries and therapeutic interventions are appropriate for the utilization of technology as a component of, or instead of, in-person provision of physical therapy care.

Physical therapy providers shall be guided by professional discipline, the best available evidence, and any existing clinical practice guidelines when practicing via telehealth. Physical therapy interventions and/or referrals/consultations made using technology will be held to the same standards of care as those in traditional (in-person) settings.

To learn more about Getting Paid for Telehealth Physical Therapy, click here: https://bit.ly/3S0BZdJ, Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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