Transitional Care Management has been created by the Centers for Medicare and Medicaid Services to provide reimbursement opportunities for communication with a patient following a facility or hospital discharge (these are specified below). The communication involves a "checking in" on the patient within two business days of their discharge date along with an office or home face-to-face visit within seven or fourteen calendar days of discharge depending on the complexity of the decision making centered around the patient.
CPT Codes To Know:
99495:
Communication with patient or caregiver within two business days of discharge (Business days are Monday-Friday except holidays). This may be a phone call, an email, direct contact, etc.
Face-to-face visit within 14 days of discharge (Calendar).
During the service period the decision making surrounding the patient must be at least moderate complexity.
Covers a 30 day period.
Average reimbursement:
Facility: $112.00
Non-Facility: $166.50
99496:
Communication with patient or caregiver within two business days of discharge (Business days are Monday-Friday except holidays). This may be a phone call, an email, direct contact, etc.
Face-to-face visit within 7 days of discharge (Calendar)
During service period the decision making surrounding the patient must be high complexity.
Covers a 30 day period.
Average reimbursement:
Facility: $162.00
Non-Facility: $234.97
To check reimbursement for TCM in your area click the link below.
https://www.cms.gov/apps/physician-fee-schedule/license-agreement.aspx
Services to be Provided Under TCM:
Hospital Settings That a Patient may Transition From:
Long-Term Care hospital
Inpatient Acute Care hospital
Inpatient Psychiatric hospital
Skilled Nursing facility
Inpatient Rehabilitation facility
Hospital Outpatient Observation or Partial Hospitalization
Partial Hospitalization at a Community Mental Heath center
Non Face-to-Face Services to be Provided Under TCM may Include:
Connection made to patient and/or caregiver within two business days post hospital discharge (phone, email, face-to-face).
Communication with community services or home health agencies the patient may wish to utilize.
Education given to patient and/or caregiver that supports independent living, daily life, or self-management.
Assessment and support of patient treatment regimen and management of prescribed medication.
Discern available community and health resources that may be of use to the patient.
Coordination of access to care and or services that may be deemed useful to patient.
Note: These services may be provided by clinician staff when done under the direction of the physician (or qualified healthcare professional).
Non Face-to-Face Services to be Provided by the Physician may Include:
Collection and review of discharge information
Review of patient's need for, or follow-up on, treatments and pending diagnostic tests.
Schedule and completion of Face-to-Face visit.
Communication between TCM physician and any qualified healthcare professional who may assume or re-assume patient care upon completion of TCM.
Education of caregiver and/or patient
Arrangement or Re-arrangement of referrals and/or community services one may recommend to the patient.
Assistance with scheduling follow-ups with community providers and/or services.
Note: These services can only be provided by a physician or other qualified healthcare professional.
What ThoroughCare Does for you:
Breaks TCM process into four easy steps (Review Discharge Info, Initial Communication, Non Face-to-Face, Face-to-Face / Finalize)
Provides tools to schedule/record the Initial Communication and a Face-to-Face visit
Allows for organized documentation of non face-to-face requirements (ei. Medications on discharge, Appointment coordination, documentation of findings, etc)
Includes a checklist of patient progression through TCM
Keeps track of upcoming and missed deadlines
Supplies helpful tools to successfully fulfill TCM services
Other Information:
This service extends over a 30 day period.
If the patient is readmitted before end of 30 days then the TCM period will start over. If a face-to-face visit was completed already it can be billed as an Evaluation and Management visit.
A discharge visit does not count as the face-to-face visit for TCM
TCM may only be billed by a single practice for a given patient in the 30 day period.