HealthExtent

Overview

Approximately 1 in 5 admitted patients in the United States are readmitted to the hospital within 30 days of discharge highlights a significant issue within the healthcare system. This phenomenon is often referred to as hospital readmissions, and it has several important implications for patients, healthcare providers, and the healthcare system as a whole:

HealthExtent's Transitional Care Management (TCM) service is designed to streamline the care transition process for patients as they are admitted and discharged from the hospital, facilitate real-time data access for Primary Care Physicians (PCPs), and ensure healthcare providers receive reimbursement for TCM services. Here's how it works:

Integration with Healthcare Facilities

HealthExtent's TCM service is integrated with the electronic health record (EHR) systems used by healthcare facilities, including hospitals and post-acute care facilities. This integration allows for seamless data sharing.

Patient Admission and Discharge

When a patient is admitted to the hospital, HealthExtent's system is notified in real-time. The system begins tracking the patient's journey from admission to discharge.

Real-time Data Collection

HealthExtent's TCM platform collects and compiles real-time data about the patient's condition, treatment plan, and care team interactions throughout their hospital stay.

This data includes:

Medication changes and prescriptions.
Diagnostic test results.
Consultations with specialists.
Nursing notes and vital signs.
Discharge planning details.

Care Plan Development

Based on the real-time data collected, HealthExtent's system assists in the development of a comprehensive TCM care plan for the patient. The care plan includes post-discharge instructions, medication management, and follow-up appointments.

Notification to PCP

HealthExtent's system assists in the discharge planning process by coordinating with the hospital's care team to ensure a smooth transition. This may include arranging for home health services, durable medical equipment, or specialist follow-up appointments.

Post-Discharge Follow-up

After discharge, the patient's care continues to be monitored by the TCM platform. It sends reminders and alerts to the patient and the PCP for follow-up appointments, medication adherence, and any potential issues.

TCM Reimbursement Breakdown

Medicare Transitional Care Management (TCM) Reimbursement Breakdown

Code

99495

$170

(as of 2022)

With moderate
(face-to-face visit)

Code

99496

$254

(as of 2022)

With high complexity
(face-to-face visit)

Requirements

Requires a face-to-face visit within 14 days of discharge.
30 minutes of medical decision-making beyond discharge.
Development of a comprehensive care plan within 7 days.

Requires a face-to-face visit within 7 days of discharge.
60 minutes of medical decision-making beyond discharge.
Development of a comprehensive care plan within 7 days.
Communication with other healthcare providers involved.

Notes

Please note that the reimbursement amounts mentioned here are approximate and may vary depending on geographic location and changes in Medicare reimbursement rates. Additionally, providers should ensure they meet all the documentation and service requirements outlined by Medicare to qualify for reimbursement under these TCM codes. Always refer to the most current Medicare guidelines and fee schedules for the latest information on TCM reimbursement.