Consider this as a new reward to the specialist practices around the country from the Centre for Medicare and Medicaid Services to treat patients with just a single chronic condition. Principal Care Management (PCM) mimics Chronic Care Management which can be done outside of the physician’s office and does not require face-face interaction. It allows physicians to provide extra care for patients with serious illnesses by keeping them out of the hospital while generating passive revenue for the work they already do.

Do you know?

6 out of 10 Americans are diagnosed with at least one chronic condition while 4 out of 10 suffer from more than one.

68% of beneficiaries have a couple or multiple chronic diseases whereas 36% have four and more chronic diseases.

Chronic condition treatment and mental health treatment costs 90% of health care expenses. Compared with primary care, the treatment cost of the chronic condition is costlier.

When it is required to set a principal care management module?

When the patient’s condition is severe enough which cannot to be handled by a primary care physician, is at risk for hospitalization, and complications, and is in need of special care with a specialist’s intervention then PCM is recommended.

Chronic conditions create a huge health risk and financial burden on the Medicare population of the United States.

For whom?

PCM should be provided for patients who are suffering from the least Single and serious chronic disease, which may lead to hospitalization or death, or functional decline.

It may be continued for 3-12 months or till the condition is resolved or stabilized. The time requirement is 30-60 minutes per month. PCM offers management for the stabilization of their chronic condition and prevents the complications of the disease.

CMS also approved two new codes for PCM: G2064 & G2065

G2064: 30 minutes of physician time a month for $92.03 for each patient.

G2065:  Additional 30 minutes of clinical time a month for $39.70.

PCM can be billed under the above-mentioned codes. Communication with the patient is documented below which requires:

• Patient’s verbal agreement for participation.
• Documentation of the disease
• Disease-specific Patient Care Plan
• Description of services provided previously
• And the Time spent

How does Principal care management differ from CCM?

Principal Care Management is the new care management code for the specialist from CMS which enables extra care for patients with serious and single chronic conditions.

It requires consultation/treatment by specialists 30 minutes a month compared with 20 minutes of CCM.

Managing patients with one chronic condition and stabilizing the patient’s health condition to prevent exacerbation and further complications.

We go beyond expectations in offering quality care for our patients. Our care coaches consider Medicare PCM management as a service to the patient and not an occupation. We make every step easy with PCM, billing claims through automated services. Contact us to know more.

Related Article: How Principal Care Management can Improve Medic’s Profit?