Who receives the payer payment?
The eligible billing practitioner or organization receives any supported claim payment under its payer arrangement. A code price is an allowed amount, not guaranteed collections.
Talk with 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
Programs to consider for your patients
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 billingHow to choose—and what must be verified
For a standalone ambulatory surgery center (ASC), begin with recovery coordination and existing covered services. Assess TCM only for a qualifying facility discharge to the community and a practitioner who accepts responsibility for the transition.
Medicare 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.
PAYMENT & FINANCIAL PICTURE
How would payment and practice costs work?
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.
What does PrimeVital charge?
PrimeVital’s operational fee is set in a written agreement. The practice also plans for clinician review, any device expense, patient cost sharing and unsuccessful claims.
The treating practitioner may bill a qualifying Part B service—not automatically the facility or agency.
Check enrollment, the exact service, stay dates, place of service and existing services. A Part A stay and care after discharge are different situations.
- The TCM illustration below applies only to a verified qualifying transition, not every surgical discharge. The required TCM visit is included in the transition service.
- For routine ASC recovery, compare the support fee and retained staff work with your current process. Model no new TCM collections unless the discharge, practitioner, complete service, and billing rules qualify.
Illustrative TCM model
These starting figures are hypothetical. They are not Medicare rates, a PrimeVital quote, or a payment forecast. PrimeVital pilot terms are not modelled automatically. Replace them with your verified contract, service mix, and cost assumptions.
Estimate net after your agreed service fee and other costs
Enter the total fees from your written agreement. No fee is prefilled. Pilot service fees are paid from collections; treatment of denied or insufficient collections must be agreed before launch.
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.
Illustrative collections before service and practice costs: $3,500. This uses the hypothetical per-patient amount and collection rate above; it is not a code-specific Medicare estimate.
To estimate the amount remaining for the practice, open the cost section and enter the total service fee from a written proposal. We do not invent a PrimeVital price or show a misleading net amount before that is known.
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.
THE WORKING PROCESS
Two routes: routine recovery or a qualifying transition
An illustrative operating workflow. Agree on the exact roles, clinical protocol, records, and service scope before launch.
- 1
Identify the route
Center + receiving practitioner
Document where the patient was discharged from. Routine same-day ASC discharge alone does not establish TCM.
- 2
Make the handoff
Discharging team + receiving practice
Send discharge instructions, medication changes, pending tests, and follow-up needs. Confirm which clinician owns recovery concerns.
- 3
Contact and triage
Qualified clinical team; administrative support for scheduling
For qualifying TCM, arrange clinical contact within 2 business days. For ordinary ASC recovery, follow the center’s approved protocol and escalate clinical questions.
- 4
Complete the clinical follow-up
Receiving practitioner
For TCM, complete the required visit within 7 or 14 calendar days as applicable and medication reconciliation by that visit. For routine recovery, follow the relevant surgical plan.
- 5
Verify the service route
Billing lead
Review the complete transition, decision-making, global-period restrictions, and other claims. Evaluate ordinary recovery support by workload and follow-through when no new claim applies.
Your first step
Identify the actual discharge setting and receiving practitioner. Separate routine ASC recovery and services included in the surgical global period from any independently qualifying transition before discussing new reimbursement.
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.
Routine same-day ASC procedure
Coordinate instructions and follow-up as an operational service; do not model a new TCM payment.
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.
COMMON OWNER QUESTIONS
Resolve these before committing.
Can the center bill TCM for everyone sent home?
No. The discharge setting, receiving practitioner’s role, complete service, and payer rules determine eligibility. A routine ASC discharge is not one of the qualifying TCM settings.
Can Interactly perform the required clinical contact?
Administrative scheduling and message collection can support the process. The required clinical contact needs appropriately qualified clinical personnel able to address the patient’s status and care needs.
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
Continue on your phoneScan to open a pre-addressed email draft.Email contact@theprimevital.com