Mount Carmel Health Partners HEDIS Tip Sheets | Page 32

HEDIS Tip Sheet  

Transitions of Care (TRC)

Definition: Percentage of discharges for members 18 years of age and older who had each of the following services.

Service Needed:
o
Notification of Inpatient Admission. Documentation of receipt of notification of inpatient admission
on the day of admission or the following day.
o Receipt of Discharge Information. Documentation of receipt of discharge information on the day of
o Patient Engagement On or after Inpatient Discharge. Documentation of patient engagement (e.g.,
o
discharge or the following day.
office visits, visits to the home, telehealth) provided within 30 days on or after discharge.
Medication Reconciliation Post-Discharge. Documentation of medication reconciliation on the date of
discharge through 30 days on or after discharge (31 total days).
Coding:
CPT 2
CPT4
1111F
99495
99496
REQUIRED EXCLUSION: Members in hospice are excluded.
OPTIONAL EXCLUSION: Exclude both the initial and the readmission/direct transfer discharges if the last discharge
occurs on or after December 1 of the management year.
Chart Review Tips:
Notification of Inpatient Admission
 Documentation must include evidence of receipt of notification of inpatient admission on the date of
admission or the following day.
 Documentation must include evidence of receipt of notification with a date stamp.
 Any of the following may be used:
o Communication between ER and the members PCP or ongoing care provider to admissions (e.g.,
o Communication about admission to the member’s PCP or ongoing care provider through a health
phone call, email, fax)
information exchange; an automated admission discharge and transfer (ADT) alert system; or a
shared electronic medical record system
o
Communication about admission to the member’s PCP or ongoing care provider from the member’s
health plan
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