For more than 8 years, Transitional Care Management (TCM) has remained to be one of the best medical bills incorporating Remote Patient Monitoring (RPM). RPM is a unique and essential part of care management. It enables providers to monitor patients at high risk for complications closely. This is all while the patients remain in the comfort of their own homes. But what is TCM? What does it provide? Well, this article will explain how to use Transitional Care Management when billing and the many ways in which it can help your practice.
What is TCM in Medical billing terms?
TCM is a set of services that are furnished to Medicare beneficiaries who are discharged from a hospital or skilled nursing facility (SNF) and who have recently been seen by a physician for a related medical condition. Transitional Care Management aims to ensure that patients receive the necessary care and support after leaving the hospital to avoid complications and readmission.
According to the Code of Federal Regulations, you can provide inpatient rehabilitation therapy within 30 days after discharge by a physician or other qualified health care professional apart of Medicare. The therapies must be medically appropriate and required for the patient’s treatment of their illness. They must also be ordered by the doctor who treated the patient during hospitalization.
What Does Transitional Care Management (TCM) Provide?
TCM provides several benefits for both patients and providers. For patients, it can help to ensure a smooth transition from one care setting to another. It can also help to prevent complications and readmissions by providing close monitoring and support.
For providers, TCM can be a valuable tool for care management. It can help to reduce the number of readmissions. As well as provide a way to bill for care management services. TCM can be very beneficial for healthcare providers who are caring for a large number of sick patients with several chronic illnesses.
TCM also includes an array of services, such as patient education and medication management. You can deliver these services through regular contact with the patient, either in person or via telehealth. Patients must fulfill specific criteria in order to receive TCM services. This can include being at high risk for complications and having several chronic diseases.
How to Use TCM When Billing
When billing for TCM services, there are a few things to keep in mind. First, it is important to make sure that the patient meets the criteria for TCM services. Second, it is important to document all the services provided. And third, it is important to use the correct codes when billing for TCM services.
The easiest way to make sure that you are using the correct codes when billing for TCM is to use a billing template. Several different templates are available, and you can find one that fits your specific needs. Once you have a template, you can simply fill in the information for each patient and then submit the claims.
What are Transitional Care Management codes?
The Centers for Medicare and Medicaid Services (CMS) created two codes to describe TCM treatments:
- 99495: This code applies to persons discharged from the hospital or SNF who see a doctor within 14 days of discharge.
- 99496: This code indicates a patient who was discharged from the hospital or an SNF and has been seen by a doctor 15-29 days after discharge.
You can use these codes to treat patients who are at significant risk of complications and have many chronic diseases.
You can bill these codes on a per-patient, per-month basis. Physicians must document their activities in the patient’s medical record to bill for TCM services. Documentation must include the date of discharge, the date of the first post-discharge visit, and a description of the services provided.
What is the difference between Transitional Care Management (TCM), Principal Care Management (PCM), Chronic care management (CCM), and Remote Patient Monitoring (RPM)?
The difference between these types of care management is the services they provide and how often you can use them.
The difference between TCM and PCM is that TCM focuses on patients who are transitioning from one care setting to another (such as being discharged from the hospital). In contrast, PCM focuses on patients who receive routine primary care services. RPM is used to monitor patients who are at high risk for complications remotely, using technology such as wearable devices.
PCM aims to provide comprehensive, coordinated care for individuals with chronic illnesses. You can utilize CCM to manage the continuing care of persons with long-term conditions.
Related Article: Maximize Value-Based Care with CCM and RPM
Conclusion
TCM is a type of care management that can be a valuable tool for both patients and providers. When billing for TCM services, it is important to make sure that the patient meets the criteria for TCM. Also, that you are using the correct codes, a billing template can be a helpful way to make sure that you are using the right codes when billing for TCM services.
