The Ultimate Quick-Reference Guide to CMS TEAM Mandate Regulations
- SolvEdge
- May 23, 2025
- 6 mins read
The CMS TEAM (Transforming Episode Accountability Model) Mandate is redefining how hospitals document, deliver, and get reimbursed for care. With sweeping changes set for 2025 and full integration into IPPS in FY26, healthcare leaders must be ready for a new level of regulatory rigor. This guide distills the most important rules, timelines, and readiness criteria into a concise, executive-friendly reference—perfect for compliance officers, RCM teams, and population health strategists.
In this post, we break down what healthcare leaders need to know to ensure their networks are TEAM-ready.
What Is the TEAM Mandate?
The TEAM Mandate is a CMS-led initiative designed to:
- Standardize episode-based care delivery and reporting
- Improve risk-adjusted reimbursement accuracy
- Advance equity through SDoH data integration
- Enforce accountability through real-time quality metrics and documentation
- Replace fragmented models with cohesive episode bundles
TEAM builds on CJR, BPCI, and ACO learnings—while removing opt-outs for many hospitals.
TEAM is the formalization of CMS’s intent to hardwire accountability into every care episode. It’s not just a model—it’s the new standard.
Core Components of the TEAM Mandate
Here’s a step-by-step playbook:
1. Mandatory Bundled Episodes
Hip & knee replacement
Heart failure
Chronic obstructive pulmonary disease (COPD)
Major vascular procedures
Oncology pathways (pilot only)
2. Documentation & Coding Alignment
CDI teams must align clinical notes with HCC-driven logic
Real-time ICD-10-HCC crosswalks required
Bundle-specific attribution rules now enforceable via audit
3. PROM & SDoH Reporting
Capture of Patient-Reported Outcome Measures becomes mandatory
Standardized Social Determinants of Health fields must be included in intake/discharge
SDoH impacts future risk scores and quality benchmarks
4. Audit-Ready Compliance
CMS will conduct monthly claim audits via TEAM Connect
Hospitals must maintain a compliance dashboard
Repeat outliers flagged for potential reimbursement suspension
CMS TEAM 2025 – Key Timeline Milestones
| Date | Action |
|---|---|
| Q3 2024 | Final rule publication in IPPS FY25 update |
| Q1 2025 | Pilot MSAs begin mandatory participation |
| Q3 2025 | CMS begins real-time performance scoring |
| FY26 | TEAM fully integrated into national IPPS reimbursement |
| FY27 | Potential expansion to outpatient and ASC bundles |
Many hospitals—especially mid-size and rural systems—face these issues:
- EHRs that don’t support bundle-level logic
- Disconnected PROM tools with no data pipeline
- Manual SDoH capture in unstructured fields
- No real-time audit alert system
- Outdated claims processing rules
The result? Incomplete data, inaccurate risk scoring, and compliance failures under TEAM.
Quick Compliance Checklist for Hospitals
Use this reference to determine your current state of TEAM readiness:
- CDI workflows include bundle-specific diagnosis pathways
- PROMs are collected at pre-op and 30/60/90-day post-episode checkpoints
- SDoH data is structured and consistently captured
- You use an HCC crosswalk engine or module within your EHR
- Internal audits are aligned with TEAM Connect flags
- Revenue cycle staff are trained on TEAM claim submission standards
If you answered “No” to more than two, it’s time to take action.
SolvEdge Insight – Leading the Shift to Dynamic Risk Adjustment
SolvEdge simplifies TEAM mandate alignment through:
AI-powered HCC crosswalk tools built into EHR documentation
Automated PROM & SDoH data pipelines
TEAM-ready dashboards and audit logs for compliance tracking
Analytics for bundle cost forecasting and quality score monitoring
Consulting to prepare your coding and CDI teams for TEAM audits
Whether you’re starting your journey or mid-way through implementation, SolvEdge delivers TEAM-ready infrastructure out of the box.
Bookmark This, Share It, Use It
TEAM is not just another CMS model—it’s the foundation of a new reimbursement paradigm. This quick-reference guide is your blueprint for policy literacy and operational success.
The sooner your organization adapts, the better your outcomes—both clinical and financial—will be in the TEAM era.
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Frequently Asked Questions
No. Hospitals in selected MSAs will be required to participate in TEAM. CMS will assign bundles and attribution automatically.
Via CMS TEAM Connect submissions. Failure to capture patient-reported outcomes may lead to quality penalties.
Only if it supports real-time HCC crosswalk logic and TEAM bundle attribution.
Stay ahead of CMS compliance.
Book a free consultation with SolvEdge to assess your TEAM documentation, risk, and reporting readiness.
