Care Transitions: Billing for Transitional Care Management

A new Centers for Medicare & Medicaid Services (CMS) Condition of Participation (CoP) will require hospitals to send real-time e-notifications of any admissions, discharges or transfers (ADT) to post-acute care providers with established care relationships who need that information for treatment, care coordination or quality improvement activities. This is good news for independent physicians, who aren’t usually notified when their patients are hospitalized. Lack of notification has made it difficult to meet TCM billing requirements that specify contact with patients within two business days of discharge and follow-up visits within seven or 14 days post-discharge, depending on the level of medical complexity. CoPs are the health and safety standards that health care organizations must meet to participate in Medicare and Medicaid. The new CoP goes into effect on May 1, 2021. More

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