Medical Claims

# Transitional Care Management Services: How to Get Paid

- March 11, 2022
- Posted by Kristen Edwards

11 Mar

It is no secret that Medicare is cutting reimbursement for transitional care management (TCM) services. In fact, the payments have been slashed by almost 50%. This means that practitioners must be even more diligent in ensuring that their claims are submitted correctly if they want to be reimbursed for these services. In this article, we will cover the basics of billing for TCM services. We will discuss what information needs to be included on the claim form, as well as some of the most common mistakes that are made when submitting a claim for TCM services.

1. ### What is transitional care management (TCM)?

TCM is an important medical service that helps patients make the transition from one medical setting to another (for example, a hospital or rehab facility back home).

#### The TCM service includes several components:

– A face-to-face visit with the patient within 14 days of discharge. This visit should be at least 30 minutes long. During this time, you will perform a physical exam and review all medical records related to the patient’s condition(s) and care plan. You will also discuss any changes in medications, make necessary follow up appointments for additional treatments or tests, provide instructions about how to resume daily activities safely after recovery from surgery or illness etc., coordinate communication between other providers involved in their care such as pharmacists & therapists, and answer any questions the patient may have.

– Up to five additional face-to-face visits with the patient (15 days apart) that are at least 15 minutes long.

– Daily telephone contact with the patient for up to 30 days following discharge.

The TCM service must be furnished within a 30-day period beginning on the date of discharge from the hospital or other medical setting.

Medicare will only reimburse for services provided by a qualified practitioner, such as a physician, nurse practitioner, clinical nurse specialist, or physician assistant. Services provided by a social worker, physical therapist, occupational therapist, speech therapist etc., are not reimbursable under Medicare Part B.

TCM is not a stand-alone service. It must be furnished in conjunction with other medical services that are covered by Medicare Part B, such as office visits, home health care, and skilled nursing facility services.

The purpose of transitional care management is to help patients make a smooth transition from one medical setting to another and to prevent any potential medical complications that may occur during this time period. By providing timely follow up care and daily telephone contact, the practitioner can ensure that the patient receives the necessary medical attention and support they need during this critical juncture.

Medicare will only reimburse for transitional care management services if they are provided in accordance with certain requirements. In particular, the service must begin within 14 days of discharge from a hospital or other medical facility and extend for 30 days from that date.

The practitioner must also submit a claim form with all of the required information, including a detailed history and physical examination report documenting any medical conditions present at discharge as well as any changes in medications or other treatments prescribed during this period. Medicare will not reimburse for services provided prior to filing an initial claim within two years after discharge (i.e., if you file your first TCM service bill six months after discharge).

Medicare Part B will only pay 50% of the reasonable charge incurred by medical providers who furnish transitional care management services; however, there is no annual deductible requirement under this program so beneficiaries are responsible for paying their coinsurance amount out-of-pocket at each medical visit.

The first medical service covered by Medicare Part B is the face-to-face visit with the patient within 14 days of discharge from a hospital or other medical facility, which must be at least 30 minutes long; however, if additional medical services are provided during this time period (such as office visits) then these can also count toward satisfying this requirement.

Medicare will only pay for transitional care management services that were furnished on or after January 16th 2013. If you are billing TCM service dates prior to 01/16/2013, your claim may be denied due to untimely filing of claims (i.e., if more than two years have elapsed since discharge). Medical providers who provide transitional care management services should be familiar with the billing and claim submission requirements in order to ensure that they are properly reimbursed for their services. In this article, we will cover some of the basics while billing for transitional care management (TCM) services.

2. ### The benefits of TCM for patients and health systems have

TCM for patients and health systems have been well documented in the medical literature.

In particular, transitional care management can help to reduce hospital readmissions, prevent medical complications, and improve patient satisfaction.

Many practitioners have difficulty being paid for TCM services. In many cases, claims submitted for TCM services have not been paid due to several common errors in claim submission.

In this article, we will cover some of the basics while billing for transitional care management (TCM) services.

The following are a few tips to ensure that your TCM service is reimbursed by Medicare:

- The entire 30-day TCM service must be furnished within a 30-day period beginning on the date of discharge from the hospital or other medical setting;
- The service must be furnished by a qualified provider.
- The appropriate date of service must be reported on the claim form.
- Claims should be filed within two years after discharge from the medical setting.

If you are billing TCM service dates prior to 01/16/2013, your claim may be denied due to untimely filing of claims (i.e., if more than two years have elapsed since discharge).

Medical providers who provide transitional care management services should familiarize themselves with these requirements in order to ensure proper reimbursement for their services.

3. ### How to get paid for providing TCM services

In order to be paid for providing transitional care management services, the medical provider must submit a claim form with all of the required information, including a detailed history and physical examination report documenting any medical conditions present at discharge as well as any changes in medications or other treatments prescribed during this period.

Medicare will not reimburse for services provided prior to filing an initial claim within two years after discharge (i.e., if you file your first TCM service bill six months after discharge).

Medicare Part B will only pay 50% of the reasonable charge incurred by medical providers who furnish transitional care management services; however, there is no annual deductible requirement under this program so beneficiaries are responsible for paying their coinsurance amount out-of-pocket.

Many practitioners have difficulty being paid for transitional care management (TCM) services. In many cases, claims submitted for TCM services have not been paid due to several common errors in claim submission.

4. ### Tips for implementing a successful TCM program

The medical provider must submit a claim form with all of the required information.

A detailed history and physical examination report is necessary to document any medical conditions present at discharge as well as any changes in medications or other treatments prescribed during this period.

Medicare Part B will only pay 50% of the reasonable charge incurred by medical providers who furnish transitional care management services; however, there is no annual deductible requirement under this program so beneficiaries are responsible for paying their coinsurance amount out-of-pocket.

Medical providers who provide transitional care management services should familiarize themselves with these requirements in order to ensure proper reimbursement for their services.

### Conclusion:

Despite the reimbursement cuts, TCM services are still a valuable part of care for patients transitioning from the hospital to home. By following these tips, you can ensure that your claims are submitted correctly and that you receive fair reimbursement for the services you provide.

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