Transitional Care Management Program

What is Transitional Care Management (TCM)

Transitional Care Management (TCM) services address the hand-off period between the inpatient (e.g., hospital or a skilled nursing facility), and community setting. The essence of TCM is that a health care provider takes charge of the patient’s care from the instant he or she has been discharged. Transitional care management is designed to last 30 days. It involves a medical professional engaging in one face-to-face visit with the patient and then additional non face-to-face meetings (such as by telephone or a video call, as is the case with telemedicine).

Required Elements of CMS compliant TCM program

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Contact the beneficiary or caregiver within two business days following a discharge. The contact may be via telephone, email, or a face-to-face visit. Attempts to communicate should continue after the first two attempts in the required business days until successful.
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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.
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Medicine reconciliation and management must be furnished no later than the date of the face-to-face visit.
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Obtain and review discharge information.
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Review the need for diagnostic tests/treatments and/or follow up on pending diagnostic tests/treatments.
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Educate the beneficiary, family member, caregiver, and/or guardian.
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Establish or re-establish referrals with community providers and services, if necessary.
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Assist in scheduling follow-up visits with providers and services, if necessary.

Benefits

TCM, done right, is the best way to increase your practice revenue, decrease hospital readmissions, along with increase patients’ satisfaction.

Transitional Care Management Billing Codes

Code

Description

Summary Requirements

Payment Average

99495

Face-to-face visit, within 14 calendar days of discharge

Includes:

Communication (direct contact, telephone, electronic) with the patient/caregiver within 2 business days of discharge from an inpatient hospital setting;

 

Medical decision-making of at least moderate complexity during service period;

 

Face-to-face visit within 14 calendar days of discharge

$188

99496

Face-to-face visit, within 7 calendar days of discharge

Includes:

Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge from an inpatient hospital setting;

 

Medical decision-making of high complexity during the service period;

 

Face-to-face visit, within 7 calendar days of discharge

$248

How Can We Help

It has never been more important to improve your patients’ outcomes, especially to decrease readmissions. There are a lot of questions about Transitional Care Management (TCM) implementation including required elements, billing, software, staff and more. Dr. Koyfman has been consulting large and small companies on TCM. She developed and managed one of the first and very successful TCM program in Maryland, where the readmission rate was reduced by 65%. Click here to schedule introduction call @ https://calendly.com/dr_irina/30min