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Principal Care Management Rules Every Provider Should Know

Image explain the principle care management.

In these days’s healthcare landscape, chronic disease management is essential to making better patients. Principal Care Management (PCM) is designed to assist carriers manage sufferers with single, excessive-danger chronic situations. Whether you’re handling patients with severe bronchial asthma, diabetes, or coronary heart failure, PCM permits committed care and a common communique to keep away from hospitalization and functional decline.

What is Principal Care Management?

Principal Care Management (PCM) is a healthcare model developed to cater to patients with a single chronic condition that has lasted for at least three months. According to the Centers for Medicare and Medicaid Services (CMS), PCM focuses on dealing with conditions that place patients at a high risk of:

  • Hospitalization
  • Acute exacerbation
  • Functional decline
  • Death

PCM offers a personalized approach to care, where physicians or clinical staff develop tailored care plans, provide regular check-ins, and make timely adjustments to medication regimens. This comprehensive care helps stabilize the patient before they are transitioned to a primary care provider or continue regular disease management.

PCM CPT Codes and Billing Guidelines for 2024

In 2024, CMS introduced 4 new CPT codes for Principal Care Management, which changed the previous HCPCS Level II codes G2064 and G2065. These codes permit companies to bill for the time they spend dealing with a single excessive-danger situation.

The four PCM codes include:

  • 99424: First 30 minutes of PCM services provided by a physician or other qualified healthcare professional for a high-risk disease.
  • 99425: Each additional 30 minutes of PCM services is provided by a physician, billed separately.
  • 99426: First 30 minutes of PCM services provided by clinical staff under the supervision of a physician.
  • 99427: Each additional 30 minutes of PCM services are provided by clinical staff, billed separately.
  • It’s crucial to notice that those services can best be billed as soon as per calendar month, and at least 30 minutes of clinical time need to be documented.

Key Differences Between PCM and CCM

While PCM and Chronic Care Management (CCM) services are both imperative to continual sickness care, they fluctuate in numerous methods:

  • PCM focuses on a single high-danger continual situation, even as CCM deals with the control of or more conditions.
  • PCM codes are billed monthly based on clinical personnel or doctor time, at the same time as CCM calls for 20 minutes of scientific time consistent with the month.
  • PCM does not mandate regular care plan updates every 60 days, unlike CCM.

Understanding these differences is essential for accurate billing and ensuring the best care for your patients.

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Documentation Requirements for PCM Services

Just like any care management service, PCM requires detailed documentation to comply with CMS medical billing rules. The following information must be recorded:

  • Patient’s chronic condition
  • Risk factors (age, comorbidities, functional decline)
  • Care plan and any revisions
  • Clinical time spent providing PCM services
  • Outcomes (improvements in health or stabilization)
  • Coordination with other healthcare providers

By keeping these records, you can ensure proper reimbursement and maintain high-quality patient care.

Improve Patient Engagement and Increase Revenue

Implement PCM in your practice is not only about improving patient outcomes but also offers a new revenue stream for billing practitioners. With the right systems and support, healthcare providers can efficiently manage high-risk patients, increase engagement, and secure more consistent reimbursements through PCM billing.

At Cures MB, we specialize in helping providers navigate the complexities of PCM billing. Our team ensures you get the most out of Medicare’s reimbursement opportunities while focusing on delivering the best care to your patients.

 

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We are a team of national medical billing service experts based in Astoria, NY, committed to providing ongoing value to our customers. We leverage technology and implement best practices to provide high-quality and cost-efficient medical billing solutions from domestic locations, enabling customers to achieve their business goals. Cures Medical Billing is the best option for any medical billing needs.

Medical billing around Astoria, NY, and beyond is our core competency and our specialists will efficiently manage all your billing needs. Our medical billing specialists have over 12 Plus years of experience with all security technologies to ensure data integrity for our customers. Using our medical billing service, anyone can make their medical billing task less resource-consuming.

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