Transitional Care Management codes, 99495 & 99496, are designed to reduce potentially avoidable hospital readmissions. CMS estimates the annual cost of these potentially avoidable readmissions at $17 Billion annually, the amount spent per beneficiary doubles per readmission.
In an effort to reduce readmissions CMS implemented a program that would fine hospitals based on a set performance algorithm. According to Health Catalyst, in 2013, Medicare levied 276 fines for excessive readmissions. It is estimated by MedPac that 78% of hospitals will be fined in 2016 between 1%-3% with the average penalty totaling $160,000 per hospital.
Transitional Care Management is the process of managing patients during their transitions of care. Calling them post-discharge, reviewing their discharge instructions, performing a medication reconciliation, providing patient and beneficiary education, assisting the patient with subscribing to community resources and more.
This can seem like a daunting task but the benefit to the patient and the industry is significant in contrast. To ease the burden of performing these duties many organizations are reaching out to third-party service providers that can absorb some or most of these tasks.
Entities are given the option of minor assistance, i.e. third-party providing initial patient outreach only upon discharge, to full support, i.e. provider performing face-to-face services only. The myriad of options and flexible solutions can create a win-win for physicians and hospital systems.
Physicians can bill CMS to be reimbursed for TCM services and this focused-approach to reduce readmissions will help area hospitals avoid potentially hefty fines from CMS. In addition, the CDC estimates that for every 100 discharged patients, approximately 20 have two or more chronic conditions. Which means a solid TCM program can also help guide your CCM program and could potentially increase your referral base with the hospital.
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