Step-By-Step Recipe for Transitional Care Management

One of the greatest opportunities for increasing savings and efficiency – and for improving outcomes - is providing appropriate follow-up care for patients discharged from institutional settings.  Study after study demonstrates that health systems that have implemented even the most rudimentary transitional care management programs realize impressive results. 

For the first time, the 2013 Medicare Physician Fee Schedule includes reimbursement for post-discharge transitional care management services. Specifically, Medicare now pays physicians and other qualified non-physician professionals for post-discharge transitional care management services (TCM services) under two new CPT codes, 99495 and 99496. Based on the 2013 conversion factor, the national payment rates for TCM are $163.99 (for 99495) and $231.36 (for 99496). 

The Centers for Medicare & Medicaid Services (“CMS”) anticipate two-thirds of all discharges will be eligible for TCM.  Based on these estimates, CMS expects to spend well over $1 billion on TCM services in 2013.

A well-designed and well-run TCM program – one that identifies and enrolls eligible patients and provides the required post-discharge services in an efficient manner- can generate significant revenue, especially if commercial payors follow CMS’ lead and pay for these services.  Also, the savings from reduced readmission and other costs avoided are significant.

Our new white paper, Transitional Care Management Programs:  The Time Is Now, provides a step-by-step explanation of the Medicare billing rules for TCM services.  The paper also details how providers can organize TCM programs to take advantage of this new source of revenue.

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