May 2016


by Billed Right Admin

Transitional Care Management Services (TCM) is a service that can be valuable to medical practices. Despite that the fact that TCM can be utilized by physicians of any specialty, certified nurse-midwives, clinical nurse specialists, nurse practitioners, and even physician assistants, TCM isn’t widely used across the country. Knowing how TCM works will help your practice build even more revenue throughout the year. This is where BilledRight shines. We can break down the process and help you implement TCM in your own office, making your practice a more streamlined and efficient entity. There is a 30-day TCM period that begins on the date the beneficiary is discharged from the inpatient hospital setting and continues for the next 29 days. The requirements of TCM are as follows:

  • The services are required during the beneficiary’s transition to the community setting following particular kinds of discharges
  • The health care professional accepts care of the beneficiary post-discharge from the facility setting without a gap?
  • The health care professional takes responsibility for the beneficiary’s care and the beneficiary has medical and/or psychosocial problems that require moderate or high complexity medical decision making

TCM Services are rendered to a patient based off of a discharge of one of the following:
  • Inpatient Acute Care Hospital;
  • Inpatient Psychiatric Hospital;
  • Long Term Care Hospital;
  • Skilled Nursing Facility;
  • Inpatient Rehabilitation Facility;
  • Hospital outpatient observation or partial hospitalization; and
  • Partial hospitalization at a Community Mental Health Center

After a discharge from one of the above settings, the beneficiary must be returned to either his/her home, his/her domiciliary, a rest home, or assisted living.

Within the 30 days (starting the date the beneficiary was discharged), the following three TCM components must be furnished: an interactive contact, certain non-face-to-face services and a face-to-face visit.

After a TCM service has been rendered, only one health care professional may report the service, and it must be only one reported service per beneficiary during the 30 day TCM period. The minimum BilledRight would need to collect on these services for your practice are as follows: date the beneficiary was discharged, date that an interactive contact was made to beneficiary or caregiver, date of face-to-face and complexity of medical decision making (moderate or high).

Understanding this simple process is all the ammunition needed to better stream-line your office with Billed Right’s help. At the end of the day, we are here to address your billing needs and make your practice the most efficient as can possibly be.