In a study of Medicare data, researchers found that transitional care management utilization increased fourfold from 2013-2018, from 298,000 in 2013 to 1.3 million in 2018.1

“This was a descriptive analysis, so we don’t have causality,” says Leah Marcotte, MD, FACP, clinical assistant professor in the department of medicine and associate medical director for population health at the University of Washington School of Medicine. “The purpose was to describe the use of these services, nationally, in Medicare, over the study period. These included transitional care services billed to Medicare over the study period, which covers the first year — in 2013 — when it was a billable service.”

Investigators also examined the rate of denial. “In 2013, the denial rate was 37.3%, compared to a 4.9% denial rate in 2018,” Marcotte says. “What you would expect is that as people get better and understand doing a new service, we would hope the denial rates would improve because people are more experienced in delivering the transitional care management services.”

The data analyzed included total services billed, total payments paid under accepted services, and total denied payments. “The total over the course of the study period was $931 million, with about $122 million in denied payments,” Marcotte says. “The total denial rate over the study period was 7.5%.”

Researchers looked at two different total care management services, billed under the numbers 99495 and 99496. They are billed at different rates.

“We’re interested in the use and impact of care coordination services being introduced by the Centers for Medicare & Medicaid Services, particularly in the last 10 years,” Marcotte says.

The first transitional care coordination code helped to improve the delivery of care services, she notes.

“In my role, administratively, as medical director for public health, we oversee some of the centralized services for care management,” Marcotte says. “We call patients and provide a transitional care management service. We make sure people are seen within seven to 14 days at the primary care provider clinic.”

Marcotte also delivers transitional care management services for patients in her primary care practice.

Researchers found site of service to be consistent with national trends. “All my transitional care management services are done in the clinic,” Marcotte says. “There are a minority of home-based services, where people are seeing people at home to deliver care management.”

Transitional care management is a service defined as a nurse calling the patient within two business days after the patient was hospitalized. Then, the patient has to be seen in the clinic within seven to 14 days to bill services, she says.

REFERENCE

  1. Marcotte LM, Reddy A, Zhou L, et al. Trends in utilization of transitional care management in the United States. JAMA Netw Open 2020;3:e1919571.