Lower Readmission Costs
Hospital readmissions cost around $26 billion annually and result in poor patient outcomes. To decrease hospital readmissions, CMS launched Transition Care Management (TCM).
What Is Transition Care Management?
TCM reimburses clinicians for providing continuity of care services during the first 30 days of a patient’s discharge from a hospital or skilled nursing facility. Also, CMS has removed the ban you can now billed for RPM CCM and TCM service in the me month.
2 Must-Know TCM Codes
99495 – $187.67 Transitional Care Management Services with the following required elements:
- Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge
- Medical decision making of at least moderate complexity during the service period
- Face-to-face visit, within 14 calendar days of discharge
*99496 – $247.94 Transitional Care Management Services with the following required elements:
- Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge
- Medical decision making of high complexity during the service period
- Face-to-face visit, within 7 calendar days of discharge
Below is a list of Our Services and Additional CMS requirements for TCM:
Requirements
- Patient must be discharged from an inpatient hospital setting (acute hospital, rehabilitation hospital, long-term acute care hospital), partial hospital, observation status in a hospital, or skilled nursing facility/nursing facility. (Emergency department discharge does not qualify)
- Patient must be discharged to their community setting, home, domiciliary, rest home or assisted living.
- TCM starts the day of discharge and continues for the next 29 days.
- There must be interactive contact with the patient or their caregiver within two business days of the discharge.
- Discharge medications must be reconciled before or during the face-to-face visit.
- The face-to-face visit must be made within 14 calendar days of the discharge.
- Medical decision making must be moderate or high during the service period.
- Some Medicare Administrative Contractors (MAC) indicate the medical decision making is determined at the face-to-face visit.
Services by Our clinical staff
- Obtaining and reviewing the discharge information
- Reviewing the need for or follow-up on pending diagnostic tests and treatments
- Interaction with other qualified health care professionals who will assume or reassume care of the patient’s system-specific problems
- Education of patient, family, guardian, and/or caregiver
- Establishment or reestablishment of referrals and arranging for needed community resources
- Assistance in scheduling any required follow-up with community providers and services
- Communication (with patient, family members, guardian or caretaker, surrogate decision makers, and/or other professionals) regarding aspects of care
- Communication with home health agencies and other community services utilized by the patient
- Patient and/or family/caretaker education to support self-management, independent living, and activities of daily living
- Assessment and support for treatment regimen adherence and medication management
- Identification of available community and health resources
- Facilitating access to care and services needed by the patient and/or family
At St Vincent Preventative Family Care, we help maximize TCM reimbursement.Don’t leave money on the table. Reach out today.