TEJ: Transitions of Care
Four rates: notification of admission, receipt of discharge info, patient engagement post-discharge, med rec.
Measure description
Four rates: notification of admission, receipt of discharge info, patient engagement post-discharge, med rec.
Eligible population
Medicare members discharged from inpatient
Performance drivers
Star measure for MA.
Documentation & PA strategy
TCM coding (99495/99496); med rec; discharge instructions; follow-up scheduling.
Why HEDIS matters for prior authorization
Health plans align prior authorization criteria with HEDIS measures: documenting your patient meets the HEDIS definition often streamlines or eliminates PA hurdles. For Medicare Advantage in particular, plans are heavily incentivized via Star Ratings to push members and providers toward measure compliance, which translates into faster approvals for measure-aligned services.
Frequently asked questions
What does HEDIS measure TEJ measure?
Four rates: notification of admission, receipt of discharge info, patient engagement post-discharge, med rec.
What drives performance on this measure?
Star measure for MA.
How should clinicians document for this measure?
TCM coding (99495/99496); med rec; discharge instructions; follow-up scheduling.
What is the eligible population?
Medicare members discharged from inpatient
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