Transitional Care Management "TCM" Codes: Increasing Collaboration with Home Health Agencies
Monday, March 11, 2013
by: VNAA Policy Team

Section: Public Policy and Advocacy




Effective January 1, 2013, new CMS Transitional Care Management (TCM) billing codes permit physician reimbursement for communication with home health agencies about a beneficiary’s care.
 
In 2012, the Centers for Medicare and Medicaid Services (CMS) sought stakeholder input on a new reimbursement structure to reward physicians for post-discharge care management services. The goal was to incentivize providers for improving a beneficiary’s transition from the hospital setting to the community setting.
 
In response, the American Medical Association (AMA) and several physician groups organized and recommended that CMS create new billing codes to pay physicians for post-discharge care transition and care coordination activities. CMS approved that recommendation and on January 1, 2013, CMS began reimbursing physicians and other qualified non-physician professionals under two new TCM codes, 99495 and 99496, for successfully transitioning a patient out of institutional care and back into the community.
 
While only physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified nurse midwives can bill for TCM services, these incentives stand to enhance the relationship between hospitals and home health providers. The new TCM codes support enhanced coordination efforts and qualifies these efforts for reimbursement as non-face-to-face care management services.
 
More information about this new code, click here.

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