Transitional Care Management (TCM) helps patients in the first 30 days following a hospital discharge. Covered by Medicare Part B, providers should learn what CPT billing codes are used for TCM in order to optimize care delivery and avoid denied claims.
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A transition of care (ToC) involves moving a patient from one care site to another. These “moments of truth” are critical to ensuring continuity of care that is safe, efficient, and supports a successful healthcare journey.
Understanding the CPT billing codes for Transitional Care Management (TCM) will provide you with a better idea of what is expected, both by the patient and by Medicare.
Value-based care requires providers to meet specific quality performance metrics. Failure to do so can negatively impact financial reimbursements and disappoint patient expectations. But even with these penalties, some organizations struggle to adopt this approach to primary care, as the course to do so isn't always straightforward.
Reimbursement rates for Transitional Care Management (TCM) are tied to the program’s Current Procedural Terminology (CPT) codes. These codes help categorize and specify billing rules and requirements for the procedures, treatments, and care services related to TCM.
Implementing value-based care can help providers improve patient health and reduce care costs, but it has introduced new, overwhelming challenges to physician practices.