Transitional care is often critical and always time-sensitive. With Medsien’s TCM solution, you can identify more eligible patients and obtain discharge reports faster with the most advanced technology.
Tacking the day-to-day of TCM programs can be an unwieldy process. Medsien’s bidirectional EHR integration simplifies the entire workflow and automates the most time-consuming tasks at each stage, from discharge to home transition.
Tracking and logging all the crucial details of TCM programs takes away from more valuable services, like transitioning patients properly. Let Medsien’s automated platform crunch the numbers and handle claims while you focus your efforts where it counts.
Medsien algorithms can identify patients that are discharged from hospitals in your area where you are the primary care provider.
Our staff will then contact your patients to schedule an appointment for them within 7 or 14 days of their discharge.
After the patient visit, our software keeps tracks of your claims to provide detailed financial reports.
With ever-growing number of technology integrations,
you can get up and running with Medsien in a matter of days.
Medsien client at a multispecialty care clinic
Contact us to see Medsien in action and learn how your organization can reimagine remote care management.
Transitional care management (TCM) is intended to reduce potentially preventable readmissions following discharge from an inpatient encounter. TCM requires initial contact with the patient within two business days after discharge and a face-to-face visit within a specified period of time.
Transitional care involves a 30-day period that begins on a patient’s inpatient discharge date and continues for the next 29 days. TCM services begin the day of discharge from an inpatient or partial hospitalization setting.
Examples of transitional care management include taking responsibility for a patient’s care, supporting that patient’s transition to a community setting, such as a home or nursing facility, and making moderate or high-complexity decisions regarding their medical issues.
Transitional care management benefits patients after discharge from an inpatient encounter by providing continuous care without service gaps. TCM also benefits practices by reducing the chance of readmission or rehospitalization.
You must provide at least three components of transitional care management during the 30-day period: interactive contact within 2 business days, 1 face-to-face visit, and medically reasonable and necessary non-face-to-face services, like patient education and medication management.
The goals of transitional care management are to effectively provide continuous care during the 30-day TCM period and transition a patient back to their home, domiciliary, nursing facility, or assisted living facility.
Transitional care management is evaluated by the type of medical decision-making involved. Patients who receive TCM must require either moderate or high complexity, which is defined by multiple, extensive diagnoses and significant complications, morbidity and mortality risk.
Transitional care management services are defined by the Centers for Medicare & Medicaid Services (CMS). Thus, reimbursement for these services is only available to patients who meet CMS eligibility and providers who meet CMS requirements.
Yes, as long as a patient is eligible for transitional care management, Medicare does reimburse TCM services. CPT codes through a TCM program include communication with the patient or caregiver within 2 business days of discharge, face-to-face visits, and medical decision-making of moderate complexity (99495) and high complexity (99496).
Medsien’s TCM solution makes it easy to implement a transitional care management program in as fast as just a few days. Reach out to our team of TCM experts today to get started.