How do you realize the maximum potential of a Transitional Care Management (TCM) program?
Medicare requires specific benchmarks to be met for your practice to seek reimbursement.
If you miss any of them, you’re looking at a financial loss. Medicare may deny your claim.
As we’ll cover below, these benchmarks are the exact means to deliver service to your patients.
But how do you keep track of everything? How do you ensure efficiency and effectiveness?
Utilizing care coordination software is one way.
At ThoroughCare, we’ve helped healthcare organizations derive the most value from care management and wellness programs.
In this article, we’ll cover the benefits of care coordination software to streamline the TCM process.
With this information, you’ll have a better understanding of why such technology is crucial for TCM management.
Medicare created TCM to provide patients with continuous health services in the first 30 days after a hospital discharge.
The goal is to ensure the patient avoids readmission.
The patient’s discharge must be from one of the following settings:
Primary care doctors and specialists, as well as non-qualifying medical practitioners, may offer TCM services.
These services consist of three segments.
They are interactive contact, non-face-to-face services, and office visit.
All are mandatory within a specific timeframe, as required by Medicare to fulfill TCM. Unless they are determined to not be medically necessary.
This is simple, initial outreach to the patient or their caregiver. It is required to be performed within two business days following the patient’s hospital discharge.
Contact may be made by telephone, email, or face-to-face.
It may be made by the provider or clinical staff. The conversation will touch upon the patient’s general well-being, as well as the next steps in the TCM process.
Non-Face-to-Face services may be performed by either the physician or clinical staff.
Services vary depending on who is providing them.
For the physician, services include:
For clinical staff, services include:
An in-person office visit is a final step. It should occur within either seven or 14 days of the patient’s hospital discharge.
This time frame depends on the complexity of medical decision-making inherent to caring for the patient.
Medical decision-making refers to establishing a diagnosis and/or selecting a care management option, which is determined by the following factors:
Medicare utilizes two different CPT codes to distinguish between office visit types. These are separated and labeled as involving either moderate or high complexity decision-making.
Please note: Office visits are part of the overall TCM service. They should not be reported separately.
To deliver the three service segments covered above, you’ll want a system in place to track and manage TCM.
A practical resource, such as care coordination software, will keep key details from being lost or overlooked. For you and your staff, this will promote a more efficient process.
Below, we cover three of the benefits this software solution can provide to aid with TCM management.
As covered above, TCM revolves around a 30-day timeframe. Two of its three service segments require action by predetermined deadlines.
Care coordination software will help meet these requirements.
Simple features, such as built-in scheduling and time management tools, will assist clinical staff with patient outreach and office visits.
It’s crucial to consider the timing when providing TCM services to patients, and software will keep your practice on time.
Care coordination software is a great way to create a paper trail of patient data and services.
This can help you hedge against a possible audit by Medicare, as well as provide exceptional medical care.
Such software will vary in what exactly it can document, but some common examples are:
As well, care coordination software can create patient chart summaries, circumventing such a need from your Electronic Health Record (EHR).
This attention to documentation will ensure your practice’s TCM program is effective.
Lastly, care coordination software can streamline your practice’s overall TCM process by providing a go-to workflow to follow.
These steps can include:
As the provider, your input in the overall TCM process may be limited to the office visit, but for your staff, a guided process will go a long way toward consistent, quality care service.