Understanding PCM

With effect from 2022, Medicare stopped using two Healthcare Common Procedure Coding System G codes and started accepting four new CPT codes for principal care management (PCM) – CPT Code: G2064 and CPT Code: G2065. According to experts, the new codes give doctors the chance to increase outcomes while also increasing their earnings because they are paid at a greater rate than the G codes.

In that both services are provided to patients who need continuous clinical monitoring and care coordination, PCM and chronic care management (CCM) are comparable. To be eligible for PCM, patients must only have one complicated chronic condition, as opposed to three or more for CCM, which is the opposite of PCM.

How Will PCM Affect Healthcare Industry?

Practitioners may now be compensated for giving their patients care management solutions that are more focused within their own specific area of specialty thanks to the new PCM codes. A patient’s primary care doctor may nevertheless offer more comprehensive care management services as necessary. The new PCM codes, like the CCM codes, may be used in conjunction with Remote Patient Monitoring codes (CPT Codes 99453, 99454, 99457, and 99091), and they may be used incidentally by a billing practitioner while being overseen by the clinical personnel performing the services.

Learn About the Principal Care Management Billing Criteria

Patients must have one complex chronic disease that satisfies all six of the following requirements in order to be eligible for principal care management (PCM) billing.

1. Should persist for at least three months.
2. Significantly increases the patient’s risk of hospitalisation, acute decompensation or aggravation, functional decline, or even death.
3. Needs a care plan that is particular to the disease to be developed, monitored, or revised.
4. Requires frequent modifications to drug schedules, and/or the condition’s care is extremely difficult because of other conditions.
5. Demands constant contact and care coordination amongst pertinent healthcare providers.
6. Requires PCM services for at least 30 minutes each calendar month.

Benefits of PCM

Similar to CCM, Principal Care Management (PCM), also offers benefits to both, the patient and the provider.

1. Stabilization of Chronic Condition: One of the main objectives of PCM is to stabilise a patient’s chronic condition as soon as feasible so that the patient’s primary care physician can take over overall responsibility for their treatment. The patient would pay far less for healthcare as a result.
2. Preventing Secondary Chronic Condition – The benefit of treating a chronic ailment as soon as it manifests is that it significantly lowers the likelihood of a new, secondary chronic condition developing. The care and attention that patients receive from their healthcare professional is one overarching benefit of all of CMS’s initiatives.
3. Opportunities for Reimbursement – CMS enables providers to get PCM reimbursements, providing your practise with an extra source of income.

How Can Physicians Provide PCM Effectively?

 Patient Selection – PCM is not necessary for all individuals with complex chronic conditions. Be sure to note that the patient’s condition is so severe that hospitalisation is either imminent or that the patient has already received multiple hospitalisations as a result of the disease.

Patient Consent – Document the patient’s consent, and make sure to note that you’ve informed them that their coinsurance is in effect.

Bill Correctly – Report CPT codes 99424 and 99425 if a physician or non-physician performs the PCM, and record CPT codes 99426 and 99427 if a clinical staff member or other certified professional supervises the service directly.

Outsource PCM Services – Identify the PCM service types you are presently offering, but not charging. Do you have the ability to charge for those services in order to maybe defray the expense of recruiting a new employee who may also be qualified to offer CCM and TCM services? Outsourcing your services to a third party is also a beneficial option. You can opt for an offshore medical billing agency to assist you with your PCM services that can assist generate more revenue with minimal errors.

Maximize Collections and Improve Patient Care with Info Hub Consultancy Services (ICS)

CMS enables providers to increase revenue streams and enhance patient outcomes through PCM. You may manage your patients more effectively by using our PCM solution, which has many of the same features and resources as our CCM solution. In order to increase your revenue and guarantee patient happiness, ICS, an offshore medical billing company, offers its expertise with patient care enrolment and consent forms, plan assessments, and monthly PCM time tracking.

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