Routine same-day ASC procedure
Coordinate instructions and follow-up as an operational service; do not model a new TCM payment.
Contact us FOR YOUR PRACTICE
Surgical practices and ambulatory surgical centers
Coordinate discharge instructions, patient questions, and follow-up while checking whether a separate transition claim is actually available.
RELEVANT PATHWAYS
Does every discharge create a TCM opportunity?
No. A routine ambulatory surgical center discharge does not qualify for Medicare TCM. A qualifying hospital or facility transition may fit an eligible practitioner, subject to deadlines and the global-surgery rules.
TCM · Transitional Care Management
Only after a qualifying discharge, with an eligible practitioner accepting transition responsibility.
Patient example, requirements, and billingRPM · Remote Physiologic Monitoring
Consider only medically necessary monitoring that meets its own rules, including the global-surgery boundary.
Patient example, requirements, and billingCheck this before choosing a programMedicare does not pay TCM if any of its 30-day period falls inside a global surgery period for a procedure billed by the same practitioner. Routine ASC discharge is outside the eligible TCM settings.
EXAMPLES FOR YOUR SETTING
Start with a real need in your practice.
These scenarios show what to evaluate, rather than automatically assign a program or approve reimbursement.
Qualifying hospital discharge
The accepting practitioner may assess TCM when contact, visit, medication, and decision-making requirements can be met.
Postoperative global period
Check the procedure and billing practitioner before forecasting any separate transition or monitoring claim.
ONE ILLUSTRATIVE TCM JOURNEY
See the patient, practitioner, and support roles.
Meet Robert: he returns home after a qualifying hospital stay with changed medicines and several follow-up appointments.
Receive discharge
Day of discharge- Patient / caregiver
- Returns to a community setting after a qualifying stay.
- Treating practice
- Accepts transition responsibility and checks global-surgery and other-biller issues.
- PrimeVital’s agreed role
- Helps obtain the discharge notice and organize deadlines.
- What gets recorded
- Eligible setting, discharge date, destination, summary, and clinical owner.
The sample goal
Resolve discharge questions and complete a coordinated 30-day transition.
YOUR INVOLVEMENT
Agree on responsibilities before the first patient starts.
Your organization
The accepting practitioner owns clinical decisions and the required visit. The center provides timely records and a clear discharge handoff; the facility cannot assume a professional TCM billing right.
PrimeVital’s agreed support
The agreed team can support discharge tracking, coordination, patient follow-up, and evidence handoffs. Interactly can support scheduling and front-desk messages; clerical scheduling is not TCM clinical contact.
Service hours, professional qualifications, technology, integrations, records access, and fees are confirmed in the engagement. Front-desk automation handles agreed administrative tasks; clinical judgment and claims remain with the responsible qualified professionals.
WHAT YOU NEED TO DO
A practical launch checklist.
- Distinguish the facility’s role from the professional accepting the transition.
- Record the actual discharge setting, date, community destination, and global period.
- For TCM, meet clinical contact and visit deadlines and medication-reconciliation requirements.
- Identify other clinicians already managing or billing the transition.
- Define clinical escalation, records access, and patient follow-up ownership.
PAYMENT & FINANCIAL PICTURE
Who gets paid, and what does the practice spend?
Eligible professional TCM claims belong to the responsible practitioner when all requirements are met. ASC discharge coordination may instead be a service purchased by the center or included in its existing payment. The example below applies only to qualifying transitions.
Illustrative TCM model
These starting figures are hypothetical. They are not Medicare rates, a PrimeVital quote, or a payment forecast. Replace them with your verified contract, service mix, and cost assumptions.
Service, device, and practice costs
Illustrative agreement: fees apply to enrolled patients, even if a service does not qualify for payment.
Leave at zero if already included in the service fee. Avoid counting it twice.
Shown separately from recurring operating costs.
35 of 50 patients meet the assumed service requirements.
Collections
$3,500
Operating costs
$2,150
Contribution
$1,350
$1,750 service fees + $0 additional device costs + $400 practice costs.
Contribution is before other overhead and taxes. Actual billing uses service-level evidence and rules; this simplified model does not select codes, approve eligibility, or guarantee outcomes. Patient cost sharing and QMB protections must be checked separately.
BENEFITS TO TRACK
Choose a baseline and a review date.
Agree on the measures that matter to your patients and team.
- Discharge records received on time
- Clinical questions and medication issues resolved
- Required follow-up completed
- Unplanned returns measured against a baseline
Sources and scope
Reviewed October 7, 2026. Practice type alone does not establish clinical eligibility or payment. Detailed program pages maintain the code references; use the patient’s actual payer, professional, setting, and date of service.
YOUR PRACTICE, YOUR PATIENTS
Bring us the workflow you want to improve.
Share your practice type, patient group, payer mix, and current team. We can map the care pathway, available support, launch gaps, and assumptions to verify.
DESIGN A PRACTICAL STARTING POINT
Tell us where the workflow is breaking. We’ll show you where to begin.
Send us a message
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