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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PCMH: Assisting Primary Care Physicians as well as Patients

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pcmhassistingprimarycarephysiciansaswellaspatients.jpg

A Patient-Centered Medical Home (PCMH) is not a particular type of hospital or building but an alternative approach to delivering health care that provides coordinated, continuous patient-centric medical care, managed by a team of individuals led by a physician. PCMHs employ the latest technology available to make optimum use of time and funds in order to deliver the best possible healthcare to patients. Although the concept is not new it has gained recognition and popularity among patients and physicians alike due to the recent health reforms. There are numerous pilots being carried out in various parts of the country and the results are positive and fruitful for healthcare providers and patients.

Coordinating Patient Care

Primarily, a PCMH integrates care across the healthcare spectrum including specialists, hospitals, therapists, laboratories, druggists, and home health to avoid duplicate care and curtail errors. It aims to assist physicians in keeping up-to-date with the patient history and also helps patients by giving them the opportunity to receive care from one physician over long periods of time. This simply ensures that the physician knows the patient’s history and the patient trusts the type of care that is being provided. This in-depth knowledge of a patient’s history in a practical manner and on record allows physicians to make decisions that are relevant and efficient at the same time. It also offers extended hours which goes a long way in keeping patients out of expensive emergency rooms. Moreover, by sharing information and decision-making with the patients, it enables and supports them to manage their own care and keep healthy.

Health Information Technology

The healthcare IT sector is another feature of PCMH that helps primary care providers to enhance the efficiency of the workflow process, improve the quality of care, and provide outcome measurements as well as accountability. Physicians, nurses, and primary healthcare providers are using this technology to make informed decisions on the latest and real-time information available due to Electronic Health Records (EHR).

Time

The time factor plays a vital role in the healthcare industry and patients and physicians can suffer due to the delays in various processes. PCMH aims to ensure that patients can visit a healthcare provider without scheduling on the same day that they think they need a health check-up. Time is also saved due to the e-prescriptions which are a feature of PCMH and let the physicians prescribe medicines online. Moreover, due to such e-prescriptions, patients do not have to wait for their medicines since they are already ready to be delivered when the patient visits a PCMH.

To learn more about PCMH: Assisting Primary Care Physicians as well as Patients, click here: https://bit.ly/3q3wCPb Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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