A Deep Dive into TCM, CCM, and APCM Programs
In closer detail, transitional care benefits patients by following important directives after they leave the hospital:
- Patients can be contacted using phones, meeting with doctors, or sending emails within two days after being discharged.
- For patients needing moderate care, an in-person visit with a doctor should happen within 14 days, while patients with high complexity should see one within 7 days.
- Services for handling and correcting each patient’s medication history
- Services provided by specialists
- Learning and assistance in managing conditions
- Working with those in the community
TCM is typically billed using one of two CPT codes, either 99495 for moderate complexity or 99496 for high complexity.
Comparing Transitional Care Management (TCM) to Other Care Coordination Programs
TCM vs CCM
The aims and methods for achieving their intended goals differ in TCM and CCM, despite both using care management. The period covered by transitional care begins on discharge and lasts for only 30 days, offering support such as connecting patients with local resources and informing them about their health.
Unlike Disease Management, Chronic Care Management is focused on looking after Medicare beneficiaries with several related health problems. The goal is to enhance how people live, lower the risks of bad outcomes, help patients care for themselves, and bring together services provided by various professionals in different places. CCM offers plans tailored to each patient, access to medications, round-the-clock help from healthcare providers, easy access to health information through an electronic health record (EHR), regular touchpoints, and support for managing health on their own.
TCM vs APCM
Both TCM and APCM are aimed at helping Medicare patients go through transitions in their care settings. Both programs strive to keep patients from being readmitted by following up with them for 30 days. Both TCM and APCM rely on instructing patients and working closely with providers. Furthermore, every program can send serious matters to the pertinent care team when necessary.
Both TCM and APCM are aimed at helping Medicare patients go through transitions in their care settings. Both programs strive to keep patients from being readmitted by following up with them for 30 days. Both TCM and APCM rely on instructing patients and working closely with providers. Furthermore, every program can send serious matters to the pertinent care team when necessary.
Which Care Management Program- TCM, CCM, or APCM—Best Fits Your Needs?
Offering TCM, CCM, or APCM depends on the patients, the way billing is done, and the goals you aim to achieve. When TCM and CCM are used together or APCM alone, patients can benefit from the broadest range of services. Consider the following when deciding on your courses:
Existing transitional care services: If you already have APCM, including TCM, it would be unnecessary, since all its services are part of APCM. One month should not include billing for both TCM and APCM for the same patient.
Patient population: Clinics that have a high number of patients with chronic illnesses benefit from applying the CCM strategy, which is developed to assist those with two or more chronic conditions. On the other hand, APCM provides a larger variety of patients, as well as more services. It is not against the rules to provide APCM and CCM treatments to different patients from the same office, but it involves greater organization.
Practice care model: Those practices that rely on a fee-for-service model can find TCM and CCM useful. APCM’s main focus on quality may work well for any practice aiming to move toward value-based care while still reliant on FFS reimbursements. Whereas CCM is an aspect of value-based care, APCM brings even more focus to it.
Reimbursement projections: If you examine your patient base and estimate your expected reimbursement yearly for the various programs, you may see how to proceed. TCM and CCM may cover more costs for patients who receive prolonged assistance after obtaining care in a hospital, but APCM reimburses you more in total based on the severity of each service offered.
Intended outcome: Managing discharge in TCM and APCM helps lessen patients’ possibility of returning to the hospital and encourages them to follow preventive care. They achieve this goal by doing different things and with other additional services and goals. Take time to understand how you can improve your service, so you can find the program or programs that are right for your practice.
Gen By Gen Health's turn-key CCM/RPM solutions ensure compliance and health literacy – improving patient satisfaction and outcomes, increasing revenue, and decreasing staff workload.
To get in touch call us right now at (908)-864-0098 to learn more about our CCM services or you can also book a 30 min free consultation.
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