Medicare/Transitional Care Management

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With 15 to 20 percent of Medicare beneficiaries re-admitted within 30 days of hospital discharge, the Centers for Medicare & Medicaid Services (CMS) now is paying for “Transitional Care Management” (TCM) services supporting healthy transitions after hospital stays. This change is significant in that CMS previously has not paid for any substantial non-face-to-face services. 

Qualifying physicians, physician assistants, and advanced practice registered nurses (APRNs) can bill for TCM services, which recognize and reward the crucial work of RNs and APRNs who coordinate care for their patients. Medicare also recognized, but decided not to reimburse, new billing codes for monthly “Complex Chronic Care Coordination” (CCCC) services. However, these codes could be reimbursed in the future by Medicare and/or private payers.

For details on how the Medicare rule affects nurses in practice, ANA members can see the FAQ.