PCG Health™ has successfully guided and supported a number of agencies through the implementation of Medicaid Targeted Case Management (TCM) service billing. We have also reviewed rate setting methodologies and existing programs. PCG Health has successfully managed and maximized TCM service reimbursements for clients including child welfare, juvenile justice, and Medicaid state and local agencies. PCG Health's Medicaid TCM services include
CMS has begun implementing significant changes to how Medicaid agencies reimburse TCM services. The changes could limit reimbursement for services provided to children, in particular, if the requirements are not carefully reviewed and addressed. The revised rules would have an impact on all current TCM programs and must be addressed as part of future programs. They also impact claiming of case management activities, typically called Administrative Case Management (ACM).
If these proposed rules are implemented, many states will need to reevaluate their TCM programs and Medicaid State Plan Amendments and make changes in order to come into compliance and maintain and maximize revenue.
PCG Health has helped agencies to implement statistical allocation methodologies and time studies, including Random Moment Time Studies (RMTS), to apportion costs reasonably and accurately so they can identify TCM services, costs, and other federal revenue sources. Child welfare agencies, for example, require special consideration because TCM services may be provided in conjunction with Title IV-E administrative services. PCG has expertise in seamlessly managing these separate federal revenue streams to maximize reimbursement while maintaining compliance with federal rules.
The new proposed CMS regulations stipulate several TCM service documentation requirements, including a requirement to bill in 15 minute increments. PCG Health has expertise conducting case reviews and assisting agencies to assess their TCM services documentation and implement new documentation protocols. PCG Health™ can also assist agencies to develop new information systems to document billable TCM events.
PCG Health has run billing operations for state agencies and we understand the complexities of documenting valid dates of service and billing Medicaid services using HIPAA formatting electronic transactions.
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For more information about PCG Health's Medicaid Targeted Case Management Services please contact us at firstname.lastname@example.org or 1-800-210-6113.