The pro: Billing for transitional care management — services rendered for certain patients during their transition from an inpatient hospital setting to their home — boosts income for physician practices. In 2013, the Centers for Medicare and Medicaid Services began paying for TCM, which could, in some cases, yield physicians more than twice the reimbursement of a hospital follow-up office visit.
The con: Operational challenges make it difficult to meet regularly requirements.
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These requirements state that physicians must provide initial contact with the patient within two business days of hospital discharge. Within seven or 14 calendar days (depending on the patient’s complexity), they must provide a face-to-face visit. In addition, transitional care management is for 30 days of services, so physicians can only bill TCM once every 30 days.
Dr. Lonnie Robinson, a family physician at Regional Family Medicine in Mountain Home, Arkansas, said that without the help of technology — specifically an easy-to-use TCM app called Phyzit — he would have had a difficult time meeting TCM requirements. In a busy practice of eight family physicians and three nurse practitioners, he said it’s difficult to track hospital discharges and meet the deadlines for patient contact. That’s where the app helps. And now he bills for TCM at least once a week.
“Care coordinators don’t have to sit down and figure out who’s due for a phone call, who’s due for an office visit and what day the billing has to take place for this all to work properly,” said Robinson.
Local hospitals send patient admission and discharge information to care coordinators working at the practice who then enter this information — along with patient demographic data — into the app. Coordinators also monitor the state’s health information exchange for admission and discharge information. The app handles the rest of the work for them, notifying them as deadlines approach.
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“The care coordinators tell me it’s a good value for the price, and they would like to keep it,” he said.
Since Robinson began billing for transitional care management in March 2015, he has noticed a 40 percent increase in revenue for eligible hospital follow-up visits and a decrease in readmission rates from 13.1 percent to 8.2 percent. He said the cost of the app is minimal considering the short- and long-term payoff to ensure compliant TCM billing.
“I think TCM fits into the bigger picture of value-based reimbursement,” said Robinson. “A lot of our incentive programs are tied to a shared-savings model — especially Medicare. TCM improves your chances of achieving a Medicare shared-savings bonus if you’re involved in an ACO.”
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