What’s inside:
This article explains how the CMS TEAM model is shifting hospital coding from a compliance focus to a strategic financial lever. You’ll learn why accurate coding and charge capture are more critical than ever, how the coding process must adapt across the full 30‑day surgical episode, and how hospitals can build a coding strategy that supports cost control, quality metrics, and reimbursement risk under the model.
As CMS’s TEAM approaches its January 2026 launch, hospitals across the US are rethinking their CMS coding strategies. The model introduces new pressure and new opportunities because accurate coding will be needed for hospitals to document, code, and manage costs across entire episodes of care.
So, how is CMS coding changing under TEAM? Hospitals that leverage automated charge capture and real-time coding tools to access their true costs can protect savings and reduce reconciliation risk under TEAM.
What Is CMS TEAM and Why Coding Matters
The CMS TEAM Model is the next evolution of value-based care, designed to link hospital payments to patient outcomes and cost efficiency. Hospitals will continue billing fee-for-service, but at the end of the year, CMS will reconcile total episode spending against set target prices for procedures like joint replacements, spinal fusions, and cardiac surgeries.
If hospitals deliver care below that target (while meeting quality metrics), they share in the savings. If they exceed it after Year 1, they may owe CMS money back.
That’s where accurate CMS coding becomes crucial. Every line of code from device identifiers to modifiers directly affects the hospital’s reported episode costs, documentation quality, and overall CMS reconciliation results.
How CMS Coding Changes Under TEAM
Under the traditional system, coders focused on ensuring compliance for individual claims. But TEAM redefines the scope and impact of coding:
- Coders now support entire 30-day care episodes, not just inpatient stays.
- Documentation must clearly show whether post-acute services, complications, or readmissions are related to the original procedure.
- Charge capture gaps, especially for high-cost supplies or implants, can distort episode cost data, leading to lost savings or repayment penalties.
TEAM shifts CMS coding from a transactional task to a strategic function that drives reimbursement accuracy, quality performance, and financial accountability.
How to Prepare Your CMS Coding Strategy for TEAM
1. Audit Your Current Coding Accuracy
Start by asking: Are we capturing every charge tied to a TEAM-eligible episode?
Conduct internal audits across coding, charge capture, and documentation workflows. Look for under-coding, missing device IDs, or inconsistent modifier use. Even minor errors can compound during CMS reconciliation.
2. Align Coding and Clinical Documentation
Coding under TEAM relies on complete and clinically precise documentation. Strengthen collaboration between coders and clinicians through shared training sessions and TEAM-ready EHR templates. This ensures every implant, complication, and procedure is accurately reflected in both the medical record and the claim.
3. Automate Charge Capture at the Point of Use
Manual data entry leaves hospitals vulnerable to missed charges. Automating CMS charge capture can ensure 100% of supplies and implants are recorded in real time. Using AI-based tools with computer vision can capture complete product data and offer real-time visibility into every supply, implant, or disposable, providing the complete data needed for precise episode cost tracking.
4. Monitor Coding and Cost Data in Real Time
TEAM introduces a data-driven feedback loop between coding, finance, and quality metrics. Hospitals should integrate coding data into real-time dashboards that connect cost, utilization, and episode performance. Real-time monitoring not only identifies anomalies early but can enable hospital leadership to make proactive financial decisions, ensuring that episodes stay under cost targets.
5. Build an Audit-Ready Documentation Trail
To prepare for CMS TEAM audits, maintain transparent links between clinical documentation, charge capture, and final billing. Running internal “mock audits” for TEAM procedures helps identify weak points and ensures readiness before CMS reconciliation.
Turning CMS Coding into a Strategic Advantage
As CMS continues its shift toward bundled payments and value-based reimbursement, CMS coding becomes the backbone of financial and clinical success.
Under the TEAM model: not just about the care provided, but about a hospital’s efficiency, precision, and accountability. By integrating automation and complete charge capture into coding workflows, hospitals gain full visibility into episode costs, reduce the risk of lost shared savings, and build a defensible audit trail, turning coding into a strategic lever for TEAM success.
