Virginia Regulatory Town Hall
Department of Medical Assistance Services
Board of Medical Assistance Services
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8/15/23  1:48 pm
Commenter: Elyse Schneider, Brain Injury Services

Billing Clarification

As I mentioned previously, I was a TCM in another state and am hoping to gain clarification on Virginia's expectations for the TCM program. 

In regards to billing, are only face-to-face interactions with the client considered billable? Will phone calls of a certain time be considered billable? At my previous agency, we could bill for phone calls over 7.5 minutes long. It is mentioned in the manual under Service Requirements that TCM's will "assist the individual to participate in appointments and community resources to ensure access to care and successful facilitation of service delivery," as well as under Service Monitoring "visit with the individual and their family, and providers of service for monitoring of health and welfare and ISP implementation." With these two statements, will it be within a TCM's scope of responsibility to attend medical/mental health/other appointments with a client? With the expectation of having "at least one face-to-face contact with the individual every 90 days, which may vary based on intensity of case," will we be able to bill for multiple visits with a client a month, especially if we are attending appointments with them outside of the community? If we do attend appointments with clients, will there be restrictions on billing, such as only being able to bill for when the client meets with the provider, but not being able to bill for sitting in the waiting room with the client? Is only physical face-to-face billable, or does telehealth count? There are instances where it is not safe to meet with a client in person due to infestations, illness, and other factors. What is the expectation if a client declines meeting in person? Thank you for your time. 

CommentID: 218715