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Transitional Care Management

Approximately one in five Medicare beneficiaries in the United States are readmitted to the hospital within 30 days of discharge; up to 76 percent of these readmissions may be preventable. A common reason for readmissions is the absence of timely follow-up appointments with primary care providers to assist patients with their new diagnoses, medications and treatments.

The Centers for Medicare & Medicaid Services (CMS) recognizes the importance of this transitional period and has started paying medical providers for coordinating Medicare beneficiaries’ care transitions. The new payment plan is intended to acknowledge that effective care transitions require care coordination and provide additional reimbursement to support these activities. Since 2013 the physician fee schedule includes payment for two new CPT codes to support Transitional Care Management (TCM) services.

TCM is an opportunity for providers to receive additional reimbursement for taking responsibility for the care of patients following discharge from an inpatient hospital setting and returning to home or an assisted living facility. The goal is to decrease the high percentage of avoidable patient readmissions after discharge through more effective care at the transition.

TCM Implementation Guide

An effective Transitional Care Management (TCM) program will establish for your practice and care teams the workflows to enable timely and consistent patient discharge information flow, patient outreach and follow-up care visits, and accurate and appropriate billing. This implementation guide breaks it all down and will help your practice create and refine your TCM program.