TCM & ADT Response

How to act on every ADT notification within the TCM window.

Independent primary care practices typically capture only 30 percent of eligible Transitional Care Management visits — not because the work is hard, but because nobody at the practice knows about most hospital discharges in time. Alema connects to your state HIE's ADT feed, detects every Medicare patient discharge within hours, fires the outreach, and hits the 14-day window every time.

See how Alema closes your TCM gap

The Problem

Most TCM revenue is lost before you know it exists.

TCM has a hard clock. Moderate-complexity (99495) requires a face-to-face visit within 14 days of discharge and reimburses around $201 nationally. High-complexity (99496) requires the face-to-face visit within 7 days and pays around $273. Miss the window, lose the visit.

Without a system, TCM identification looks like this: the practice finds out about a hospital discharge when the patient calls a week later. By then the 7-day high-complexity window is already gone and the 14-day window is closing fast. Most discharges are never billed at all.

Practices on an ADT-triggered workflow — meaning they get notified within hours of discharge and have an automated path to schedule the face-to-face — routinely capture 70 percent or more of eligible TCM windows. For an independent practice with 500 Medicare patients, that's roughly $20,000 to $40,000 a year in additional captured revenue.

How It Works

How to capture more TCM revenue

01 / IDENTIFY

Every eligible patient, every day.

Alema subscribes to your state HIE's ADT feed. Every Medicare patient discharge from a hospital or SNF surfaces on the TCM work list within hours, with discharge date, days remaining in the 14-day moderate window and 7-day high-complexity window, and projected reimbursement.

02 / OUTREACH

Trigger the TCM workflow.

Within hours of discharge, Alema flags the patient on a TCM work list with the discharge date, days remaining in the moderate-complexity window (14 days) and high-complexity window (7 days), and projected reimbursement.

03 / BOOK

Secure booking page, zero friction.

The patient taps the link, lands on a practice-branded booking page, sees the full context, picks a time that works, and completes a short pre-visit intake. The appointment writes back to your EHR's schedule automatically. No app to download, no portal login, no phone call needed.

04 / CAPTURE

Bill 99495 or 99496.

Once the face-to-face visit is completed and the appropriate non-face-to-face care coordination is documented, your team bills 99495 or 99496. Alema attributes the revenue to the originating ADT trigger and tracks it in Realized Revenue.

The Math

What TCM capture looks like, by the numbers.

A typical single-provider primary care practice with 500 Medicare patients. National average reimbursement rates from the 2026 Medicare Physician Fee Schedule. ADT feed from a state HIE (free for ambulatory practices).

Annual Discharges

120-240

Medicare hospital and SNF discharges per year for a 500-patient primary care panel.

Capture Lift

2-3x

Practices on an ADT-triggered workflow typically move from ~30% capture to ~70%+.

Annual Revenue

$20-40K

Additional TCM revenue per year for a single-provider practice. Scales linearly with provider count.

Common Questions

TCM and ADT response, answered.

How does Alema detect hospital discharges?

Alema subscribes to your state Health Information Exchange's ADT (Admit, Discharge, Transfer) feed. Whenever one of your Medicare patients is discharged from a covered hospital or skilled nursing facility, an ADT message hits Alema within minutes. The system cross-references the patient against your panel, confirms TCM eligibility, and creates the work list entry automatically. No EHR integration is needed to receive the ADT — it comes from the HIE.

What's the difference between 99495 and 99496?

Both are Transitional Care Management codes covering the 30-day post-discharge period. 99495 (moderate complexity) requires a face-to-face visit within 14 days of discharge and reimburses approximately $201 nationally. 99496 (high complexity) requires the face-to-face visit within 7 days and reimburses approximately $273. Only one TCM code can be billed per patient per 30-day post-discharge period. The complexity level is determined by the medical decision-making during the visit.

What if the patient is readmitted before the TCM visit?

If the patient is readmitted before the required face-to-face visit happens, the TCM cannot be billed for that discharge period. Alema flags readmissions automatically via the ADT feed and updates the work list. If the patient is then discharged again, a new TCM window opens and the cycle restarts.

How much TCM revenue does a typical practice capture?

An independent primary care practice with 500 Medicare patients typically sees 10 to 20 monthly discharges that qualify for TCM — roughly 120 to 240 per year. Without automation, capture rates hover around 30 percent because the practice doesn't know about most discharges in time. With ADT-triggered workflows, capture rates typically climb to 70 percent or higher. The annual revenue difference is approximately $20,000 to $40,000 for a single-provider practice.

Do we need to integrate with the HIE ourselves?

No. Alema handles the HIE connection during onboarding. You sign a participation agreement with your state HIE if you don't already have one (most are free for ambulatory practices), and Alema routes the ADT feed into your dashboard. Your team's only job is the clinical work — the face-to-face visit and the documentation. Alema handles everything before and after that.

Other Revenue Engines

TCM is one of four. See the rest.

Industry statistics referenced on this site are drawn from publicly available research, government data, and primary care industry benchmarks. Examples of revenue figures, savings, and timelines shown are illustrative and not based on Alema customer data. Individual practice results will vary based on practice size, payer mix, patient demographics, provider availability, and other factors. Alema Health is a decision-support platform; nothing on this site constitutes medical, legal, billing, or coding advice. Alema Health does not guarantee specific revenue, financial, or clinical outcomes.