Transitional Care Management Consulting in Hackensack, New Jersey

According to Centers for Medicare & Medicaid Services (CMS), the requirements for TCM services include:

• The services are required during the beneficiary’s transition to the community setting following particular kinds of discharges
• The healthcare professional accepts care of the beneficiary post-discharge from the facility setting without a gap
• The healthcare professional takes responsibility for the beneficiary’s care
• The beneficiary has medical and/or psychosocial problems that require moderate or high complexity medical decision making

The 30-day TCM period begins on the date the beneficiary is discharged from the inpatient hospital setting and continues for the next 29 days.

We Provide the Following Support to Your Patients and Providers

Identification

We help to identify eligible patients and the available health resources.

Communication

We ensure a good communication with the provider and the patient in giving the right information from the EHR.

Education

We educate the patient and the provider for self-management support. We also provide training if needed.

Engagement

We provide valuable interaction between the provider and the patient to ensure that proper care is delivered.

*Note: Patients Need to be Discharged from one of the following settings: Inpatient Acute Care Hospital, Inpatient Psychiatric Hospital, Long Term Care Hospital, Skilled Nursing

Facility, Inpatient Rehabilitation Facility, Hospital outpatient observation or partial hospitalization; Partial hospitalization at a Community Mental Health Center and returned to their home, domiciliary, rest home or assisted living facility to bill for the TCM codes.

Only one from the following qualified healthcare professionals may report TCM services:

• Physicians (any specialty)
• Certified nurse-midwives (CNMs)
• Clinical nurse specialists (CNSs)
• Nurse practitioners (NPs)
• Physician assistants (PAs)

The 30-day period for the TCM service begins on the day of discharge and continues for the next 29 days. The date of service you report should be the date of the required face-to-face visit. You may submit the claim once the face-to-face visit is furnished and need not hold the claim until the end of the service period.

Two Current Procedural Terminology (CPT) codes (99495 and 99496) will be used to pay for all TCM services:

CPT Code 99495

TCM services require:

• 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

CPT Code 99496

TCM services require:

• 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

Different transitional care programs and services have been established to improve quality and reduce costs since the Affordable Care Act of 2010. The programs help hospitalized patients with complex chronic conditions transfer in a safe and good situation from one level of care to another or from one type of care setting to another. With the arrival of the Hospital Readmission Reduction Program (HRRP), providers are encouraged to give the much-needed care to the vulnerable Medicare patients upon discharge from an acute setting and to hopefully prevent readmission or re-hospitalization.

Components include in Transitional Care Management:

• An Interactive Contact
  The contact between the caregiver and the patient may be via telephone, e-mail, or face-to-face.
• Certain Non-Face-to-Face Services
  This is to obtain and review discharge information or to provide education to the beneficiary and family.
• A Face-to-Face Visit
  This is done to provide services from moderate to high medical decision complexity.
• Medical Decision Making
  Careful decision-making is needed to determine the number of possible diagnoses, the amount and complexity of medical records, and the risk of significant complications.

Let us know how we can help your organization. Reach us today!