Wiki Urgent help. please and thank you! Transitional Care Management

Create Wiki
B

bnockis

Contributor
Messages
24
Best answers
0
Good morning! We have a question that would be amazing if it could be answered today. We have a patient who was d/c'd from inpatient last Friday, 06/01/18. contact was made today to be within the two business days (after discharge) to qualify the patient for a TOC. Our provider called and the house where the patient lives (we provide services to those with disabilities, many of who live in our homes), and they stated the patient was "re-admitted" back to the ER on Sunday but also discharged on sunday. does this disqualify them for a TOC? Or is it only for an inpatient hospital stay/discharge?

Thank you so much for any help you can give!
 
Because TCM services focus on inpatient discharges, I would propose that any ER visits would not disqualify the patient from TCM services. While I didn't find any direct verbiage about this on CMS related sources, I found this from AAFP (which is close):

"Defining “discharge”
For the purpose of TCM, “discharge” refers to a discharge from an inpatient setting such as an acute care hospital, rehabilitation hospital, long-term acute hospital, or skilled nursing facility. It also refers to discharge from observation status in a hospital, or from a partial hospital program, which is a program for mental health and substance abuse disorders that involves spending the day at the treatment center and the night at home. No other discharges are
allowed under the guidelines. Emergency department discharges are excluded, as well as discharges from assisted living facilities."

So to answer your question, just because the patient went to the ER and was discharged, and because the ER is an outpatient setting, the patient should still be qualified for a TOC and thus TCM services as long as the other TCM requirements are followed.


Other good reading:
CMS TCM FAQ
Noridian (MAC)


Hope that helps!
 
That's what I had in my head, but I wanted another voice (not in my head..haha). thank you so much!
 
You must log in or register to reply here.
Top