The Power of Admission, Discharge, and Transfer (ADT) Notifications

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The Power of Admission, Discharge, and Transfer (ADT) Notifications

Wednesday, August 26, 2015

Primary care providers (PCPs) are frequently presented with opportunities that fall into "the right thing to do" category -- but lack a clear business case. Transformation would be easy if physicians were always presented with opportunities that clearly mean both better care and a directly measurable, immediately available increase in revenue.

This is what happens when a practice uses admission, discharge, and transfer (ADT) notifications to jump-start the processes that fulfill billing requirements for the Transitional Care Management (TCM) codes. The TCM codes are for follow-up after an admission from an inpatient, observation, or skilled nursing facility visit. Provided the patient is not readmitted within 30 days, the PCP bills the 99495 code in place of a 99214 evaluation and management (E&M) code for patients called within 48 business hours and seen within 14 days. The 99496 code is billed in place of a 99215 code for patients called within 48 business hours and seen within seven days.

For patients, there is an increased satisfaction in knowing their PCP is informed and following up on their care. For PCPs attempting to improve readmission scores, this helps make sure that patients understand and can adequately follow their discharge plan. Getting a patient to see the PCP within 7-14 days presents an opportunity to re-evaluate discharge instructions, check any changes to medications, and assure the patient understands how to be as healthy as possible.

TCM codes pay significantly more than regular E&M codes for the additional effort of the phone call and evaluation related to admission. The difference in revenue can be substantial. In 2014, Medicare paid $163.10 for the 99495 code versus $86.75 for the 99214 code, and $237.60 for the 99496 code versus $107.71 for the 99215 code. For one Allen Park, Michigan, practice of five physicians, the estimated increase in revenue from billing TCM codes was $27,428.02 in 2014.

For many, the limiting factor for TCM billing is the ability to know which patients are within 48 business hours of a discharge. A centralized source of up-to-date, electronic notifications of ADTs, such as the real-time notifications in online tools such as Carespective™, provides physicians with the necessary critical information. Web applications like Carespective, which is provided free for physicians in the Consortium of Independent Physician Associations (CIPA), are increasingly necessary to both support patients during a stressful period of health care and allow physicians to be paid in a manner that rewards the extra effort for quality care.

Information is provided by Medical Advantage Group, a leading health care consulting and management company. Visit for more information.