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Optimizing Transition of Care Management Visit Coding in a Primary Care Setting
Tetreault, Haley Leighton, Erin
Tetreault, Haley
Leighton, Erin
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Abstract
Effective care transitions following hospital discharge are crucial for improving patient outcomes and reducing readmissions. Transition of Care Management (TCM) billing codes were created to encourage and reimburse the additional work required for these visits. However, they are underutilized due to knowledge gaps and workflow inefficiencies. This quality improvement continuation project aimed to increase the proportion of eligible visits billed with TCM codes by 20% and increase the TCM-related visit revenue by 15% in a primary care clinic. Over a three-month period, the project implemented staff education and workflow modifications. Education addressed TCM eligibility requirements, documentation, and billing timelines for clinical and support staff. Workflow adjustments included flagging TCM-eligible visits on the schedule to improve identification and timely billing. Outcomes were measured by comparing the proportion of TCM-eligible visits accurately billed before and after the intervention and reviewing associated revenue data. TCM billing accuracy increased from 38.9% at baseline to 86.9% post-intervention, representing a 48% relative improvement. Revenue outcomes were difficult to quantify precisely due to alternative payment models and attribution through accountable care organization contracts, though TCM billing codes always lead to higher billing than traditional E&M codes. These findings suggest that low-resource, team-based interventions may improve transitional care processes and better align reimbursement with the clinical work required after hospital discharge. Future efforts should focus on longer-term monitoring, refinement of revenue measurement strategies, and improved processes to help clinical and support staff reliably identify recent hospital discharges.
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2027-05-06
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Haley Tetreault DNP Final Project Manuscript.pdf
Adobe PDF, 4.02 MB
- Embargoed until 2027-05-03
Tetreault_DNP Project Poster.4.23.26.pdf
Adobe PDF, 7.57 MB
- Embargoed until 2027-05-03