Many people suffer from chronic diseases. Sadly, the only way to treat them is through frequent monitoring and management. Doing this with an inpatient is easy, and they can access the care and attention they need from their care team. But, once they improve and their conditions get better, the hospital releases them to the community via assisted living facility or in their homes. But, transitioning from the hospital and routine care can be challenging and confusing. That is where programs like Transitional Care Management (TCM) come in. Continue reading to learn more about this program.
What is Transitional Care Management?
TCM is a billing option that pays healthcare providers for caring for a patient 30 days after discharge. It aims at improving health outcomes while reducing patient readmissions when they transition to at-home care.
CPT says that TCM reimbursement is restricted to treating patients with medical or psychosocial issues that need moderate to high complexity medical treatment when transferred to different care.
These transitions are limited to inpatient hospital settings, partial hospital, observational in the hospital, or professional nursing facility to the community setting, such as the patient’s home, rest home, domiciliary, or assisted living.
Related article: Transition Care Management
Importance of Transitional Care Management
TCM aims to improve the quality of care patients receive after discharge while reducing the costs at primary care centers, long-term facilities, inpatient clinics, and nursing homes. TCM programs help patients to continue with their care after they have been discharged from the hospital into the community.
With TCM, the patients get the needed care once they are discharged from the hospital. Their care team attends to them for 30 days post-discharge to help them adjust to their new care settings and prevent readmissions resulting from the condition worsening.
What Are the Required Components of TCM?
As mentioned, TCM cares for the patient until 30 days after being discharged. But what do the services include? Well, TCM features three components that must be furnished for proper reimbursement.
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Interactive Contact
Medicare needs providers to offer interactive care with the patient and their caregiver approximately two days after discharge. Medics can make this contact face to face or through telephone or email. Before making contact, the healthcare team needs to ensure it has the capacity for timely communication to address the beneficiary’s status and needs.
According to Medicare, the team needs to continue attempting to communicate after the first two attempts within two business days until they succeed. Please note that if you cannot make contact within this time frame but document them, you can still be reimbursed as long as you meet other TCM criteria.
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Non Face to Face Services
Medicare requires medics to offer this service unless they determine that the patient doesn’t need them or isn’t medically indicated. The teams can offer several services that don’t need face-to-face interaction. These services are usually divided into two categories; those performed by physicians and those performed by non-physicians.
Physicians can help provide the needed information to the care team members, schedule follow-up activities with the right providers, establish referrals and organize community resources, among other things. Non-physicians can help the patient and their non-clinical team to access care services, identify and communicate with the right agencies, community services, and health resources and assist a patient in remaining in their treatment regimen.
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Face-to-Face Visit
Lastly, the healthcare team will need to offer one face-to-face visit within the stipulated time. Medicare uses two CPT codes for billing; CPT Code 999495, where TCM is offered face to face within 14 days after discharge for moderate medical decision, and CPT Code 99496, which includes TCM services with high medical complexity offered face to face within seven days past discharge. Please remember that these services are part of the TCM service and shouldn’t be filed differently.
What Are the Benefits of TCM?
TCM services aim at improving health outcomes for patients who’ve been discharged. Some of the benefits they offer include:
Minimal Readmissions
According to statistics, over 17 billion dollars is spent on hospital trips after discharge that could be avoided. Also, Medicare reports a cost of about $26 billion yearly on readmissions. Also note that in 2017, hospitals that had excessive readmission rates were penalized. When readmissions are minimal, patients, hospitals, and Medicare save money.
High-Quality Care
How many readmissions occur can indicate the quality of care being offered. When they are lower, society perceives that patients are receiving quality care.
Financial Compensation
Although helping patients is your main goal, a medical practice is also a business that needs to make money. Healthcare providers can earn $167.04 per patient/month and $236.52 per patient monthly for moderately complex care and high complexity services.
Final Thoughts
Transitional Care Management can help reduce potential readmissions and medical errors while the patients transition from hospital to community care. And since TCM codes realize that the services are additional work, providers will be compensated. If you are unsure whether to include this framework in your practice, remember it may benefit your patient and your facility.
