As with all care management services, Medsien’s PCM solution enables practices to reach more people and provide additional, individualized support for their chronic conditions.
Medsien’s technology platform creates a deep, bidirectional sync with EHR systems to simplify implementation and ongoing care management.
Forget the red tape. Medsien can implement your PCM program in a matter of days, maximizing patient eligibility, streamlining enrollment and automating your administrative workflow.
...but was introduced to allow specialists to choose a chronic condition that is relevant to their field
A patient would be eligible for Principal Care Management (PCM) if they have only one chronic condition that is expected to last between three months and a year or until the death of the patient. It would be a condition that had led to a recent hospitalization and/or places the patient at significant risk of death, acute exacerbation/decompensation or functional decline.
With ever-growing number of technology integrations,
you can get up and running with Medsien in a matter of days.
Medsien intelligently identifies your patients' eligibility based on their chronic conditions and insurance coverage to maximize your practice coverage.
Medsien's Enrollment Specialists contact your patients on your behalf and walk them through the enrollment process effortlessly.
Every one of your patients will be assigned to a dedicated Certified Medical Assistant to improve engagement and deliver personalized care to your patients.
Medsien client in endocrinology
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Principal care management (PCM) is the remote treatment of patients with a single chronic condition that is expected to last at least three months and places them at significant risk of death of functional decline.
Examples of a comprehensive principal care management plan include an expected outcome and prognosis with measurable treatment goals, cognitive and functional assessment, symptoms and medication management, and planned interventions.
Principal care management benefits patients by increasing their quality of care outside their doctor’s office with improved outcomes for high-risk chronic conditions. PCM services also benefit practices by reducing costs and generating additional revenue streams for care coordination.
To be eligible for principal care management, patients must be diagnosed with a single, high-risk chronic condition lasting at least three months. This condition must be of sufficient severity to place that patient at risk of hospitalization or have been the cause of a recent hospitalization. Moreover, management of this condition is usually complex due to comorbidities and requires frequent care revisions and/or medication adjustments.
Once a patient’s verbal or written consent to principal care management has been documented and an initial face-to-face vist has been completed, a physician or qualified healthcare professional must provide at least 30 minutes of care coordination per calendar month.
Similar to CCM, principal care management includes communication with a dedicated care partner throughout the month, However, unlike its CCM counterpart, PCM only requires patients to have one complex chronic condition. PCM also requires at least 30 minutes of care coordination throughout a calendar month.
Yes, as long as a patient’s chronic condition is eligible for principal care management, Medicare does reimburse PCM services. The four CPT codes through a PCM program include the creation of a care plan (99424), additional care coordination by physicians (99425) and initial and ongoing time carried out by clinical staff (99426 and 99427).
As with most care management programs, billing practitioners for PCM services must be physicians or other qualified healthcare professionals. It is possible for a patient to receive PCM services from multiple specialists for multiple different conditions simultaneously, but PCM services should not be billed at the same time as other care management services by the same practitioner for the same beneficiary.
Under CCM, a comprehensive care plan must be developed to receive reimbursement, but for PCM, only a disease-specific care plan is required. However, PCM and remote patient monitoring (RPM) can be billed in the same month, so long as the time spent providing services under each is not counted twice.
As of 2023, national averages for reimbursement of principal care management services range from approximately $61 to $139 for each patient, depending on the billing code. This can equate to hundreds of thousands of dollars in additional annual revenue for the typical practice. With Medsien’s accurate, automated billing and coding, we achieve an average monthly reimbursement rate of 98%. Reach out to our team of PCM experts today to get started.