Transitional Care Management
Did you know, about 1 in 5 Medicare beneficiaries in the United States are readmitted to the hospital within 30 days of discharge?
Out of these readmissions, 76 percent can be avoided with proper transitional care. The absence of timely follow-up appointments with the primary care physician is considered one of the most common reasons for readmissions.
The Centers for Medicare & Medicaid Services (CMS) recognizes the importance of transitional care management and has started paying medical providers for coordinating transitional care management for Medicare beneficiaries.
What is Transitional Care Management?
Have you heard how patients who do not receive adequate levels of aftercare services often need to be readmitted?
Patients who have undergone surgery or were involved in an accident often require a follow-up visit to the doctor’s office once they are discharged. However, people neglect the follow-up visits. This is what gave rise to the transitional care management concept.
Transitional Care Management or TCM is a medical service designed for medical practitioners for the care they provide to their patients who have recently been discharged from the hospital or other facilities as qualified by the CMS.
The health care providers take charge of the patient’s care from the moment he is discharged from the hospital. Transitional care management involves a medical professional who works with the patient to ensure that there are no gaps in patient care. It is designed to last 30 days.
What Codes Should You Use To Report TCM?
Currently there are two codes that can be used to report TCM. These are:
99495 – Moderate Medical Complexity
- Communication with the patient or caregiver within two business days of discharge
- Medical decision making of moderate complexity during the service period
- Face-to-face visit within 14 days of discharge
99496 – High Medical Complexity
- Communication with the patient or caregiver within two business days of discharge
- Medical decision making of high complexity during the service period
- Face-to-face visit within 7 days of discharge
Requirements for Transitional Care Management
In order to opt for transitional care management, there are some requirements that a patient should meet.
The patient must be discharged from one of the qualifying service setting, including:
- Long-term care hospital
- Skilled nursing facility
- Inpatient psychiatric hospital
- Inpatient acute care hospitals
- Hospital outpatient observation
- Partial hospitalization
Patients Choice Mobile Primary Care Physicians
At Patients Choice & Physicians Choice we help patients transition more smoothly from a hospital or other qualifying settings to foster optimal health and wellbeing.
Transitional care management is an initiative from CMS that help improve patient’s wellbeing and avoid readmissions. This concept was designed by CMS to keep the patient healthier and prevent unnecessary relapses.
Better aftercare provided by TCM professionals help control CMS healthcare costs and reduce other unfavorable outcomes for the patient and his family members.
Team of experienced Patients Choice Mobile Primary Care Physicians provides patients with transitional care management services to help them transition from the hospital to their home. The purpose of transitional care management is to overcome barriers and prevent gaps in patient care.
Want to learn about our transitional care management services? Get in touch with our experienced primary care physicians.