When we talk about missed charges in a practice, everyone pictures the same thing: money left on the table. Transitional Care Management — TCM, the post-discharge follow-up billed with 99495 or 99496 — is the clearest example of that. But it's also the most expensive thing a practice routinely loses, because what slips away isn't just the charge. It's three things at once.
1. The revenue you can see
TCM pays, and it pays for work most of us are already doing. After a patient leaves the hospital, someone on the team is calling them, reconciling medications, and getting them in for a visit inside the 7- or 14-day window. That is exactly the work TCM reimburses. Yet practice after practice does the work and never bills it — not out of negligence, but because no one was tracking the clock on each discharge. Every one of those is pure margin walking out the door, patient by patient, month after month.
It's never a decision to skip TCM. It's a discharge on a busy day, a window that quietly closes, and a list nobody owns.
2. The value-based hit you don't see — yet
Here's the part that matters more every year. TCM exists for a reason: the days right after a discharge are when patients bounce back to the hospital. In a fee-for-service world, a missed TCM is a missed charge. In a value-based world, it's a missed chance to prevent a readmission — and readmissions are among the most scrutinized and most penalized events in every risk contract, ACO, and bundled-payment arrangement we sign.
As more of our income shifts from volume to shared savings and quality scores, the math flips. The practice that systematically closes the post-discharge loop wins twice — it captures the TCM and protects its outcomes. The practice that doesn't loses twice. Missing TCM today is a billing problem. In the value-based contracts coming, it's a scorecard problem.
3. The part that should bother us most — the patient
Strip away the codes and the contracts, and TCM is simply good medicine. It means someone checks on a patient during the most fragile week of their care — reviews the discharge plan, sorts out the new medication list, catches the small problem before it becomes a 2 a.m. emergency. When a TCM falls through the cracks, a real person doesn't get that call. That isn't a coding failure. It's a care failure — and it's the one that should keep us up at night, long before the lost revenue does.
The fix isn't working harder. It's never losing the discharge.
You can't solve this with more effort at the bedside; the willingness is already there. You solve it with a system that refuses to let a discharge disappear — where every discharge lands on a worklist with a visible countdown, owned by the team, until the follow-up is actually done. Do that one thing and you protect all three at once: the revenue, the value-based score, and the patient on the other end of the call.
I've watched too many of these slip in my own practice to believe willpower is the answer. The answer is a clock that doesn't forget — so the people doing the work finally get credit for it, and the patients who need the call actually get it.