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What you need to know to provide transitional care management services

Christine Davenport ( is the Compliance Operations Manager at Brooks Rehabilitation in Jacksonville, FL. Monica Alexanderson ( is the Manager of Brooks Center for Care Transitions for Brooks Rehabilitation in Jacksonville, FL.

Did you know there is a way to help avoid unnecessary inpatient readmissions and be reimbursed for providing post-discharge professional services to your patients? The Centers for Medicare & Medicaid Services (CMS) developed Transitional Care Management (TCM)[1] codes in recognition of care coordination that can improve patient care, enhance quality of life, and reduce healthcare costs. The TCM service focuses on the handoff between an inpatient setting and the community setting with a goal of avoiding unnecessary readmissions. Sounds good, right?

Our facility decided that these services could be beneficial to our patients who often require significant post-discharge assistance due to the severity of their conditions, such as traumatic brain injuries and strokes. Before initiating a program in your facility, you should be aware of the specific components for using TCM codes prior to implementation. Appropriate billing compliance will hinge on fulfilling these documentation requirements.

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