Principal Care Management (PCM) reimburses medical practices for the care management of patients with a single high-risk disease. For example, PCM could be appropriate for a patient with uncontrolled diabetes, uncontrolled hypertension, or a high-risk patient with severe asthma who has frequent hospital readmissions.
Principal care management is that it’s quickly evolving. The Centers for Medicare & Medicaid Services (CMS) introduced the first reimbursement codes in 2020.
Our team stays up to date on the latest policies to ensure our partners are also up to date.
While reimbursement for PCM services can give providers a new revenue stream for the billing practitioner, it also helps to engage patients more in their care plan — thought to be an essential ingredient for success in patient care (and value-based care).
A patient who is admitted to the hospital with uncontrolled hypertension. The patient may require TCM for 30 days after discharge, followed by PCM for an additional 30 days or more. If the patient develops an additional complex chronic condition that requires ongoing monitoring, they may even be eligible for CCM instead of PCM. At the same time, CMS provides two new codes for clinical staff time. Enabling your practice to get reimbursed for time spent with this patient.
Keeping up with these fluctuating conditions is complicated. It requires time, personnel, technology, and a robust management system. We already have this set up and ready to be implemented right away with our team of medical professionals in combination with our advanced technology. Ultimately this improves the care for patients and ensures you improve revenue streams.
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