Targeted Case Management

(TCM)

Rev Dec. 2008

AGENDA

• Introductions: DMHAS Staff

• Why Now?

• Definition of TCM

• Coding and Documentation

• Monitoring Activities

• Review Handouts

• Questions & Answers

WHY NOW?

• Revenue

• Budget

• System of Care

• Data Integrity

• Best Practices

TCM DATA FLOW CHART

All TCM Service data (PNP & State-Operated) entered electronically at Provider Level

DMHAS OOC Extract TCM data & sends electronic file to Collections at DAS(Department of Administrative Services)

Collections sends file to the State’s Medicaid claims administrator, (EDS) Electronic DataSystems

EDS reports total payments to DSS (Department of Social Services)

DSS bills the Federal Centers for Medicare & Medicaid Services (CMS)

The State General Fund is then reimbursed by CMS by 50%

Severe & persistent psychiatric illness as evidenced by one or more disorders as defined by the current edition of the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association that is of sufficient severity to cause serious functional impairment in any of the following domains:

Mental Health TCM Target Population

• Occupation• Social relationships• Education• Housing• Ability to manage tasks of daily living

Substance Abuse TCM Target Population

Persistent substance dependence as evidenced by one or more of the disorders as defined by the current edition of the DSM and by a history of multiple unsuccessful treatment episodes.

• TCM Services are the continuum of activities, with or on behalf of a client, concerned with

assessment, planning, linking, support and advocacy.

• TCM services include assisting a client in accessing needed housing, medical, clinical, social, educational, and other services.

Definition

Definition – Getting a Grip on TCM

“CLAMP” – a useful mnemonic tool for remembering TCM eligible services

C - CoordinatingL - Linking

A - AccessingM - MonitoringP - Planning

Acceptable Diagnoses

Specific diagnoses that can be billed under

TCM were identified and agreed upon by

DSS and DMHAS

• Cannot bill with diagnosis 799.9 - Deferred

• Most prevalent mental health diagnoses for DMHAS population included

• Definition expanded to include addiction services clients

Documentation Requirements

•Assessment

•Treatment Plan

• Progress Notes

Why We Document

• Communication among caregivers

• Communication with client about treatment goals & services

• Legal protection

• Federal & State Regulations

• Billing

• The Joint Commission

• Productivity

• Evaluation of program performance & client outcomes

• identified problem(s) / area(s) of need• at least 1 TCM goal, objective or intervention• interventions with duration/frequency and target date• responsible persons and/or community agency• must be current• evidence of client involvement

Documentation Requirements

• All documentation must be legible

• The medical record must contain an assessment:

• The treatment plan must contain:

•psychiatric diagnostic evaluation and/or •comprehensive assessment

Client Involvement in Treatment Planning

Evidenced by:

Documentation Requirements

• Progress Note detailing involvement/discussion with client

• Description of involvement on treatment plan

• Client signature on treatment plan

• if client refuses to sign - document it!

Documentation Requirements

The TCM progress note must:

document the TCM service & relate to the treatment planinclude date, time, duration & location of serviceinclude description of service include signature & credentialsinclude progress towards treatment plan goals

-“baseline” is not acceptableinclude Plan for the next time you see the client

-“Continue with plan” is NOT acceptable

- short term plan – not a reiteration of the Treatment Plan

Recovery Services

Staff spend time doing a variety of tasks

TCM is one type service type in the broad array of recovery services

Not all services are billable under TCM

You may want to use the code on the progress note & in BHIS / DPAS that matches the service being provided

•Obtaining, coordinating, maintaining resources and services (e.g., housing, entitlements, employment, legal assistance, education, transportation, etc.)

•Planning, arranging, coordinating, obtaining, monitoring, liaising or following up on specific aspect of treatment (e.g. medical tx, substance abuse treatment, appointments with other providers)

•Working with and collaborating with collaterals external to the agency including family members, landlords, employers

• Engaging the client in services (new or unengaged clients)

Examples: TCM Services

• Directly assisting with personal care or ADLs (activities of daily living), e.g., assisting with budgeting, cooking, shopping, laundry, moving residences, payee services, etc.

• Performing routine services including courier services, e.g., running errands or picking up and delivering food stamps or entitlement checks, etc.

• Providing other services that are billable through Medicaid, e.g., medical exams, treatment, therapy, counseling, etc.

• Transporting a client or family member

• Unsuccessfully attempting to provide a service such as calling and leaving a message; no shows, cancellations, etc.

Examples: Non-TCM Services

Examples for Treatment/Recovery Plans & Progress Notes

Not TCM TCMMedication delivery Monitoring self administration of

medication

Transporting client to appointments

Coordinating medical care and transportation

Budgeting /paying bills Monitoring budget to maintain ability to live in community

Moving client to new apartment

Maintaining housing; Coordinating & planning housing resources

Taking client Grocery Shopping

Monitoring clients adherence to nutritional plan

Clients Inpatient, in Nursing Homes, or Jail

Cannot use TCM code when client is:

• Inpatient• In a nursing Home

This would constitute double-billing under Medicaid

OR

• In Jail per Medicaid regulations

BHIS Service Codes - TCM

5001 TCM w/ Collateral - use when TCM services are provided with a collateral contact on behalf of a client – may include phone contacts

5002 TCM Face-to-Face w/ Client - use when TCM services are provided directly to the client in person–does not include phone contacts

5003 TCM On Phone w/ Client - use when TCM services are provided directly to the client via telephone

DPAS TCM Service Codes

• 9790Z = TCM Service Code in DPAS• Extract File:

– Provider Code Maps to 9790Z – Multiple Provider Codes can map to 9790Z in DPAS

• Reports Available to verify data:

– DPAS: cc840 Service Report

– Web-SAS Report cc843

Data required for Submitting a TCM Service for

Claim Reimbursement

Additional Documentation Requirements

TCM Service Code

Valid TCM Diagnosis

Client’s Medicaid Number

TCM services cannot be billed without a valid Medicaid Number.Please check for eligibility and accuracy.

TCM Monitoring Activities

• Internal TCM Audits - monthly review

• External Audits - Department of Social Services is mandated to conduct annual audits - results are extrapolated DMHAS-wide and determine amount of revenue retained or reimbursed to Federal government

Summary

• TCM brings in revenue

• DMHAS can bill for appropriate TCM Target Population services if properly coded and documented

• TCM focuses on “CLAMP” services

• Cannot bill TCM for ADL skill building, transportation, or medication delivery

• Each agency needs internal processes for reviewing client eligibility and chart documentation

Questions