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Happy Costumers
Transitional Care Management is a structured, Medicare-recognized program designed to support
patients during one of the most vulnerable moments in their healthcare journey — the period
immediately following discharge from a hospital, skilled nursing facility, or inpatient rehabilitation center.
For many seniors, leaving the hospital is not the end of treatment. It is the beginning of a critical
recovery window where medication errors, missed follow-ups, and gaps in communication between
providers can lead to serious complications or unnecessary readmissions. TCM exists to close those
gaps.
At 1st Care Management, our transitional care team contacts you within 48 hours of discharge to
coordinate follow-up care, reconcile your medications, and schedule an in-home visit with a licensed
nurse practitioner — supervised by a qualified physician. The goal is simple: help you recover safely at
home and stay out of the hospital
Our TCM services are designed to seamlessly pick up where your hospital care left off, with no gap in attention or support.
Our care coordination team reaches out to you by phone, email, or face-to-face visit within two business days of your discharge. This initial contact confirms your discharge instructions, identifies immediate concerns, and begins the transition process
A licensed nurse practitioner visits you at home to conduct a comprehensive assessment — reviewing
your current health status, evaluating your home environment for safety risks, reconciling all medications, and updating your care plan. Every visit is supervised by a board-qualified physician.
Between your discharge and your scheduled home visit, our team works behind the scenes to keep
your recovery on track. This includes communication with your hospital care team and specialists, education on self-management and activities of daily living, medication management assessment and
treatment follow-through, identification of community health resources that benefit your recovery, and an assessment of ongoing care and services you may need.
TCM is available to patients transitioning from an inpatient facility back into a community setting. If you or a loved one has recently been discharged from any of the following, you may be eligible.
Happy Costumers
Transitional care management (TCM) is a Medicare-recognized program that provides structured follow-up support — including phone contact, care coordination, and a home visit — for patients
recently discharged from a hospital or inpatient facility
Our care coordination team contacts every TCM patient within 48 hours of discharge via phone, email, or face-to-face visit.
Yes. TCM is a Medicare-covered service. Most major insurance plans also provide coverage.
Contact us at (833) 633-4778 to verify your benefits.
A referral from your discharging facility is helpful but not always required. You or a family member can also contact us directly to get started.
1st Care Management provides transitional care services throughout Metro Atlanta, including Sandy Springs, Roswell, Dunwoody, Marietta, Decatur, and surrounding communities
Ask us your questions directly to get clear and concise answers to your questions about home care and personalised nursing. Let us guide you through your options.
