T R A N S I T I O N A L C A R E M A N A G E M E N T R E Q U I R E M E N T S

Transitional Care Management(TCM): the assistance and service provided to senior patients as they move

from their “inpatient hospital setting”to their residence setting (personal home, rest home or assisted living).

There are several specifics healthcare providers must be aware of in order to bill for Transitional

Care Management under Medicare and Medicaid:

1 . S P E C I F I C T I M E F R A M E

• TCM starts the day after a patient is discharged

• Concludes 29 days after start date

2 . M U S T B E A Q U A L I F I E D P R O F E S S I O N A L ( Q P )

• TCM services must be rendered by a qualified professional

• That is a: physician, nurse practitioner, physician assistant, or nurse specialist

3 . I N I T I A L C O N TA C T

• Initial contact must occur within 2 business days

• Qualified Professional is in charge of documenting time & providing written summary of encounter

4 . R E A D J U S T M E N T O F M E D I C AT I O N

• Pre-admittance medication must be documented and compared to post-release medication

• Prescriptions can only come from QPs with prescription authority

5 . I N - P E R S O N V I S I T

• There must be a face-to-face visit within the first 7 or 14 calendar days of the transitional care

• The number of days depends on the code being billed for

6 . N O N FA C E - T O -FA C E I N T E R A C T I O N

• The Center for Medicare and Medicaid has a list of required services that must take place within the 30 days

• Each service must be properly documented in order to be billed.