The Centers for Medicare and Medicaid Services (CMS) proposed four new Principal Care Management CPT codes to classify care management for a single, complicated chronic disease.
These codes differ from Chronic Care Management Services(CCM), which manage two or more chronic illnesses.
These codes may be an extra revenue opportunity for allergists or healthcare professionals caring for patients with severe, high-risk asthma as they will add monthly payments exceeding ongoing E/M codes.
Principal Care Management CMS is a system that indexes or assigns interventions to patients with a chronic condition in the continuum of treatment and care.
It includes health checks, regular screenings, utilization assessments, event monitoring, short-term care coordination, and long-term chronic health condition management.
The eligibility condition for Principal Care Management (PCM) services can last between three months and one year or until the patient’s demise. PCM service is often initiated in response to a patient’s chronic disease progression or recent hospitalization.
The four new CMS Principal Care Management 2022 codes compensate physicians’ extra hours caring for high-risk, complex patients.
These include the additional time and effort required for changing prescriptions, developing a care plan, patient follow-up, and other duties.
The new Principal Care Management CMS 2022 codes, which became effective from Jan. 1, are described as follows:
First, a certified health care professional (typically a health practitioner or physician assistant) develops a disease-specific treatment plan and then makes any required changes.
These continuing modifications are anticipated and incorporated into the payment standards; for example, qualifying conditions are specified as needful “frequent revisions in the pharmaceutical regimen.”
Following that, clinical personnel, such as nurses, operate under the supervision of a physician or certified health care practitioner to carry out the treatment plan.
These include explicitly monitoring and managing the patient’s condition and medicines, regular contact, coordination with the patient, and other day-to-day delivery duties.
There are benefits of Principal Care Management for both patients and healthcare providers. Let’s look at the advantages of adopting HealthArc software for PCM services:
Develop, modify, and update patient-centered care plans easily. HealthArc seamlessly integrates with the market’s top 55 EHRs. Aside from EHRs, HealthArc connects with any device that supports external APIs, such as Bluetooth or cellular devices.
HealthArc is a clinician-friendly software that is designed to improve health standards and help you address the requirements of patients comprehensively by analyzing respiratory system status, musculoskeletal system status, and therapy compliances.
HealthArc has a dedicated Security & Compliance team to ensure privacy is incorporated into our staff, systems, and third-party interactions. All our components, including the patient interaction module, SMS, and in-app messaging, are HIPAA compliant.
The HealthArc platform allows providers to simultaneously provide RPM, RTM, and TCM care management services. Principal Care Management can be billed concurrently with remote patient monitoring as long as the monitored time is not billed twice.
Patients covered by PCM codes must fulfill the following principal care management guidelines defined by CMS:
Clinics must document the following when invoicing these codes:
Do not bill CMS Principal Care Management 2022 codes when:
|CPT Code||Billable Time||Reimbursement Rate|
Time spent by a physician or other authorized health care practitioner is coded as CPT codes 99424 and 99425.
Clinical staff time directed by a physician or other authorized health care professional is coded as CPT codes 99426 and 99427.
It is also worth mentioning that the time spent by providers and clinical personnel need not be face-to-face. It can include setting up care plans, calling patients for follow-up, etc.
When submitting a claim using CMS, you must provide the following from your records:
While it isn’t required, knowing the care manager assigned to a patient is useful in the event of an audit: When it comes to billing, you’ll keep track of the time you spend with each of your patients every month.
When billing, you’ll follow these four steps:
Never bill these codes in case:
ROI is often seen in terms of finance gained back, whereas the ROI of the Principal Care Management Program lies more in terms of benefits. PCM provides a preventive eye on patients. Their well-being can be monitored, and advanced measures can be taken in light of any fluctuations in the vitals to abnormal values.
CCM lets you provide care to patients within their homes. This helps reduce the service burden on your staff and facilities. With lesser or shared burden, you can utilize and allocate your resources more skillfully, focusing on improving the quality of care you and your practice can provide.
Chronic illnesses need immediate attention when there’s a rise in illness. When the symptoms go away, some constant monitoring is still needed.
Principal Care Management Program provides help in addressing the broad implications of chronic diseases. Thus, the burden of chronic conditions and additional illnesses and health complications reduces.
Principal Care Management Program helps in reducing the patient’s emergency visits. The extent of preventive care through the Principal Care Management Program helps in reducing the occurrence of the medical condition.
With a reduction in patient visits, some essential criteria of performance indicators measured by Medicare stay well within limits, thus helping you in keeping and improving your Merit-based Incentive Payment System (MIPS) score.
A good MPIS score further increases your reimbursement rate.
Principal Care Management Program allows meeting patients on a monthly basis. Meeting patients frequently, almost every month strengthens the bond with them. Patient engagement improves and thus results in a better care experience and more trust.
Indeed, as a healthcare practitioner, you aim to provide the best healthcare to patients. Of course, you want to receive fair compensation for the services provided.
You will need a program management system to offer and document primary care services.
A useful solution, such as healthcare management software, will prevent important facts from being lost or overlooked. These will increase efficiency for you and your staff while helping patients succeed.
Healthcare management software can help create patient care plans, staffing procedures, and billing. HealthArc software solutions provide these special features and many more.
HealthArc’s comprehensive approach to Principal Care Management enables providers to deliver care management services for their patients suffering from specific chronic illnesses by enhancing the quality metrics of their healthcare while generating healthy revenue.