New Medicare Rule to Pay APRNs for Transitional Care Management

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Under the updated 2013 Medicare Physician Fee Schedule Rule, the Centers for Medicare & Medicaid Services (CMS) now is paying for “Transitional Care Management” (TCM) services supporting healthy transitions after hospital stays. The change recognizes and rewards the crucial work of RNs and APRNs who coordinate care for their patients. It also acknowledges the high costs and poor health outcomes associated with a Medicare beneficiary hospital re-admission rate of about 20 percent within 30 days of hospital discharge. This rule change is significant in that CMS previously has not paid for any substantial non-face-to-face services.

Qualifying physicians, physician assistants, and advanced practice registered nurses (APRNs) can bill for TCM services. Medicare also recognized, but decided not to reimburse, new billing codes for monthly “Complex Chronic Care Coordination” (CCCC) services. However, these codes could be reimbursed in the future by Medicare and/or private payers.

ANA has developed a Frequently Asked Questions resource to help our members understand how this Medicare rule change will affect you in practice.