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.

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.

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

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.

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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.