Are You Missing TCM Revenue After Hospital Discharges? A Primary Care Billing Guide

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A patient is discharged from the hospital, returns to the primary care practice, and the care team spends time reviewing the discharge summary, reconciling medications, coordinating follow-up, answering questions, and managing the next steps. Then the practice bills a regular office visit. That is where some primary care practices may be leaving legitimate TCM revenue unrecognized. Transitional Care Management (TCM) is designed to account for the work involved in managing a patient's transition from an inpatient setting back to the community. Medicare's TCM framework includes communication after discharge, medication reconciliation and management, care coordination, and a required face-to-face visit. For practices handling a high number of hospital discharges, the financial issue is not simply whether the practice knows about CPT 99495 and 99496. The bigger issue is whether the practice has a reliable process for identifying eligible patients, completing the required steps on t...
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Value-Based Reimbursement in Behavioral Health

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Value-based care is also known as accountable care. A value-based care system is focused on getting value from quality services. Value-based healthcare is a payment system that rewards healthcare providers in accordance with the quality of care provided to their patients. Payments are based on better health for populations and other things, such as cost reduction, which can lead to a focus on preventative care. The benefit of value-based care is a patient in a value-based healthcare model will have fewer doctor’s visits, medical tests, and medical procedures. Additionally, they pay less on medication as their health gradually improves.
BlueCross BlueShield came into the value-based reimbursement arrangement with Value Network. The provider group has 100+ providers in behavioral health care in Western New York.
“This is another step we’re taking to build a behavioral health care model that’s designed to effectively treat the whole person,” said Dr. Thomas Schenk, Senior Vice President, Chief Medical Officer, BlueCross BlueShield of Western New York. “BlueCross BlueShield of Western New York is proud to partner with the region’s leading behavioral health care providers to introduce the first payment model designed to directly enhance quality care for our members with mental health and/or substance use disorder diagnoses.”
If you want to read the complete blog then click below: Value-Based Reimbursement in Behavioral Health
Location: United States

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