Medicaid Targeted Case Management (TCM)

PCG 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 has successfully managed and maximized TCM service reimbursements for clients including child welfare, juvenile justice, and Medicaid state and local agencies. PCG's Medicaid TCM services include:

• Consulting on new Centers for Medicare and Medicaid Services (CMS) requirements including State Plan and Program Review and Modification;
• Cost Allocation, Time Studies, and Rate Setting;
• Service Documentation Reviews;
• Services Identification and Billing.

The New CMS Requirements

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 is one of the few firms in the country to have successfully assisted state agencies with receiving approval for State Plan amendments for Medicaid TCM services under Section 1915(g) of the Social Security Act;
• PCG understands how the proposed regulations impact rate setting, service documentation, and services billing operations.

PCG Solutions

PCG is ready to assist state and local agencies with:

Cost Allocation, Time Studies, and Rate Setting

PCG 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.

Service Documentation, Identification and Billing

The new proposed CMS regulations stipulate several TCM service documentation requirements, including a requirement to bill in 15 minute increments. PCG has expertise conducting case reviews and assisting agencies to assess their TCM services documentation and implement new documentation protocols. PCG can also assist agencies to develop new information systems to document billable TCM events.

PCG 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.

Among our clients:

• State of Colorado
• State of Florida
• Commonwealth of Massachusetts

Attachments
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