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Transitional Care Management: Getting Paid for What You Do

A Transitional Care Management program may be a viable option for healthcare providers in search of new revenue streams. Read on for more.
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Want to find a new revenue stream that utilizes care management staff to provide value-based care, while allowing your physicians and non-physician practitioners to focus on other care delivery responsibilities? Implementing and operationalizing a Transitional Care Management (TCM) program may be an answer.  

TCM is a program offered by Medicare that aims at preventing hospital readmissions by focusing on the care and services being offered to patients within the first 30 days after discharge. 

To be eligible for TCM, patients must have been discharged from one of six care settings: 

  1. an inpatient acute care hospital, 
  2. an inpatient psychiatric hospital,
  3. a long-term care hospital,
  4. a nursing home, 
  5. an inpatient rehabilitation center, or 
  6. hospital outpatient observation/partial hospitalization.

Also, after discharge the patient must return to their community setting of either home, domiciliary, nursing home, or assisted living facility.

There are three components to TCM: interactive contact, non-face-to-face services, and an office visit. These three required components are offered at specific times throughout the 30-day program. These three components together are meant to provide value-based care to positively influence health outcomes while engaging the patient and their support systems, allowing the patient to receive important information gradually, rather than overwhelming with too much at once. The goal is to reduce readmissions as patients are more vested and proactive in their healthcare. 

TCM services are structured for clinical efficiency because, with the exception of one office visit, patient contact is primarily through telephone calls or telehealth platforms. With the proper technology, this program can be effective and efficient, benefiting both patients and providers. Physicians and non-physician practitioners (legally authorized and qualified to provide services in the state where they practice) must provide the face-to-face services, but can supervise auxiliary staff to provide the non-face-to-face services.  

Medicare has several CPT codes for TCM. Knowing which ones apply to the level of care you offer, the billing requirements, and the reimbursement rates is crucial in generating the revenue that is available for TCM.


The Healthcare Performance Advisory Services team at FORVIS is available to assist you in skillfully navigating the implementation and facilitation of a TCM program. Reach out to a professional at FORVIS or submit the Contact Us for information on how we can help.

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