Transitional Care Management

Easy Follow-Up

Ensure timely contact and care coordination within 48 hours of hospital discharge.

Prevent Readmissions

Identify risks early and support recovery to reduce unnecessary hospital visits.

End-to-End Support

Manage outreach, documentation, and billing—keeping your team focused

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Smooth Transitions. Stronger Recoveries

Every hospital discharge is a critical moment in a patient’s care journey. Without proper follow-up, patients face a higher risk of complications, readmissions, and confusion about medications or next steps. Our Transitional Care Management (TCM) service is designed to bridge that gap by providing timely support, education, and coordinated care. By contacting patients within 48 hours and scheduling comprehensive follow-up visits, we help practices maintain CMS compliance while significantly enhancing patient outcomes.

Comprehensive Support Without the Burden

At Merit Evexia, we manage the entire TCM process, allowing your clinical staff to focus on patient care—not paperwork. Our team handles outreach, appointment scheduling, medication reconciliation, documentation, and billing. We work behind the scenes to ensure every transition is smooth, safe, and fully compliant. By reducing administrative strain, we help maximize your reimbursements. Whether your patients are discharged from a hospital, skilled nursing facility or rehab center our TCM services help your practice stay engaged with patients, proactive in care management, and fully prepared for seamless transitions.

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our process

We Complete Every Step Carefully

01

Device Delivery

Post signup, your devices will arrive within a few days with instructions.

02

Professional Check-In

You’ll be paired with a professional who will regularly check-in with you.

03

Results Review

Health metrics will be transmitted to you to analyze the results.

Ready to transform your practice

Contact us for a demo or consultation