New Post-Hospitalization Codes Creates Revenue Stream Opportunity for Healthcare Providers

Two new transitional-care management (TCM) codes demonstrate that the Centers for Medicare and Medicaid Services (CMS) is serious about giving healthcare providers the financial support to focus on patient care after hospitalization, providing a financial incentive that should also result in reduced readmissions and  a new revenue stream.

Dr. Lauren Doctoroff, writing in Society of Hospital Medicine’s journal, The Hospitalist, has provided an excellent working explanation of the new TCM codes 99495 and 99496 in action. “As a post-discharge provider in a primary-care-based discharge clinic, I can say the new Medicare transitional codes read like our job description,” Doctoroff writes.

The new codes reimburse providers for TCM services to patients for 30 days after hospital discharge. CMS estimates that two-thirds of the 10 million Medicare recipients discharged from hospitals will be eligible to receive services under these codes, she writes.

The codes “require a single face-to-face visit within seven days of discharge for the highest-risk patients and within fourteen days of discharge for moderate-risk patients,” according to Doctoroff. “The face-to-face visit is not billed separately. The codes also mandate telephone communication with the patient or caregiver within two business days of hospital discharge; the medical decision-making must be of either moderate or high complexity.”

The new codes will be of tremendous benefit to outpatient clinics, who will be allowed to use the codes even without a pre-existing relationship to the patient, and to hospitals, for it will provide reimbursement for care for patients  ”particularly vulnerable to adverse events, including hospital readmission, given their suboptimal connection with their primary-care providers.”

More importantly, these new codes may introduce a new revenue stream for healthcare providers, the “discharge clinic.” “The new codes could make discharge clinics more financially viable by increasing the reimbursement for care that often requires more than 30 minutes,” Doctorff writes. “However, based on the experience in our clinic, the increased revenue accurately reflects the intensity of service necessary to coordinate care in the post-discharge period.”