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Transitional Care Management

TCM Consultants in Hackensack, New Jersey

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Transitional Care Management

Background
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.

Our Turnkey Transitional Care Management (TCM) Offering
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 a proper care is delivered.

Benefits of Transitional Care Management

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

TCM Reimbursement Calculator

Revenue Calculator Your Value
Average monthly number of Medicare patients discharged from one of the following settings noted below and returned to their home, domiciliary, rest home, or assisted living facility 18
Estimated average additional TCM reimbursement per patient $80
Estimated annual TCM reimbursement per provider $17,280.00

*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.

FAQs

  • What is Transitional Care Management (TCM)?
    Transitional Care Management (TCM) provides services to a patient with medical and/or psychosocial problems requiring moderate or high-complexity medical decision making.
  • What are the eligibility requirements for TCM?

    The services are provided to report for a patient following discharge from:

    • Inpatient Acute Care Hospital
    • Inpatient Psychiatric Hospital
    • Long Term Care Hospital
    • Skilled Nursing Home
    • Inpatient Rehabilitation Facility
    • Hospital Outpatient Observation or Partial
    • Hospitalization
    • Partial Hospitalization at a Community Mental
    • Health Center
  • What Current Procedural Terminology (CPT) codes to use in reporting TCM?

    You can use two CPT codes in reporting TCM:

    • 99495 moderate medical complexity requiring a face-to-face visit within 14 days of discharge
    • 99496 high medical complexity within 7 days of discharge
  • Who may furnish and bill TCM?
    • Physicians (any specialty)
    • Certified Nurse Midwives (CNMs)
    • Clinical Nurse Specialist (CNS)
    • Nurse Practitioners (NPs)
    • Physician Assistants (PAs)
  • What date of service should be used on the claim?
    The 30-day period for the TCM service starts on the day of discharge and continues for the next 29 days. The reported date of service should be the 30th day.
  • What place of service should be used on the claim?
    The place of service reported on the claim should correspond to the place of service of the required face-to-face visit.
  • What are the requirements and components for TCM?
    • Contact the patient within two business days of discharge.
    • Conduct a follow-up visit within 7 or 14 days of discharge, depending on the complexity of medical decision-making involved. The face-to-face visit is part of the TCM service and should not be reported separately.
    • Medicine reconciliation and management must be furnished no later than the date of the face-to-face visit.

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Contact Information

277 Prospect AvenueHackensack, New Jersey

855-544-0475

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