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Harvard Study Says Medical Billing System Needs Modification to Benefit All

CMS releases billing codes every year to accommodate the Medicare Physician Fee Schedule for primary care medical practices whether small or large. However, the study at Harvard University states that some codes might not translate physicians’ efforts as expected.

The study found that over a fifth of all TCM (Transitional care management) claims and a quarter of CCM (Chronic care management) claims reported to Medicare in 2016 by medical billing services were not the beneficiary’s assigned primary healthcare. It led to an open discussion if the Medicare Management Care really supports the primary care providers or not.

The Purpose of Both Codes

The TCM code is to help providers transition Medicare beneficiaries from home to home and to document the rendered services for non-face-to-face services and other coordinated services including services like telephone calls to the patient after discharge, discharge document reviews, and test follow-up.

Whereas, the CCM codes are used for enhanced care coordination services for beneficiaries with chronic conditions.  These codes specifically reimburse healthcare service providers for developing a framework to offer at least twenty minutes of non-visit based services/month. The services include reviewing lab results, interacting with professionals, or adjusting a patient’s treatment regimen, provided by the clinicians or their supervised clinical staff.

Some Codes Don’t Align with Physicians’ Efforts

CMS expected these codes to be beneficial for primary care providers. However, medical practitioners have been criticizing the Medicare Physician Fee Schedule for a long time, and there’s evidence that physicians don’t use these codes frequently.

Another study states that only about half of the primary physicians know that Medicare pays for chronic care management services.

We assume that there are several factors behind these findings. For Instance, large healthcare organizations have access to more care management codes than clinics or small medical practices.

They have access to resources that are more able to deliver quality non-visit services like telehealth than under-privileged healthcare organizations.

No matter what the circumstances may be, a consistent coding system should be devised that is beneficial for all medical billing services

All of the findings were assessed over the data of 2016, and until now, CMS has released and altered many policies and codes. Some of them were successful to meet clinicians and medical billing companies’ expectations, while others are yet to be modified.

The Harvard researchers encourage CMS to continue the practice of addressing physicians’ concerns to better support medical practices across the board. They can also try out different code sets to see which works the best for what level of practice. They also advise payers other than Medicare, to adopt the rules and reduce cost-sharing for the services.

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