Transitional Care Can Reduce Hospital Readmissions

Financing Transitional Care

The ACA provides financial resources for providers to deliver transitional care services to reduce readmissions. Since 2013, Current Procedural Terminology codes related to transitional care allow organizations to bill CMS for this care. APRNs or physicians must oversee programs that provide:

• 
  phone or e-mail contact with the patient within 48 business hours of hospital discharge
  
• 
  a face-to-face patient visit with the healthcare provider within 14 days of hospital discharge (7 days for high-complexity patients)
  
• 
  coordination services, such as review of the discharge summary, assurance that follow-up equipment and diagnostic testing are scheduled, medication management, and additional patient education.
  

If all of these services are provided to patients who require moderate- or high-intensity decisionmaking based on their physical or mental condition, transitional care codes 99495 or 99496 may be billed.