Submitting OIG:
Report Description:
Federal RequirementsPhysicians who bill for TCM services are restricted from billing for restricted overlapping care management services (77 Fed. Reg. 68985 and 68990 (Nov. 16, 2012)). Therefore, these overlapping care management services may not be billed for services provided during the same 30-day TCM service period for the same beneficiary.According to CMS officials, in these instances the first claim submitted should be paid and the second claim submitted should be denied.Physicians who bill for TCM services are restricted from billing for restricted overlapping care management services (77 Fed. Reg. 68985 and 68990 (Nov. 16, 2012)). Therefore, these restricted overlapping care management services may not be billed for services provided during the same 30-day TCM service period for the same beneficiary.According to CMS officials, in these instances the first claim submitted should be paid and the second claim submitted should be denied.
Date Issued:
Wednesday, July 7, 2021
Agency Reviewed / Investigated:
Submitting OIG-Specific Report Number:
A-07-17-05100
Component, if applicable:
Centers for Medicare & Medicaid Services
Type of Report:
Audit
Questioned Costs:
$0
Funds for Better Use:
$0
Number of Recommendations:
2