Add Chronic Care Management (CCM) and Pr...

 In 2015, the Centers for Medicare & Medicaid Services (CMS) introduced Chronic Care Management (known as CCM) with the intent of improving the care of patients with chronic conditions. CCM offers physicians an opportunity to be compensated for the work that they were doing between office visits including but of course, not limited to calls, education, coordination, and pre-authorizations. In 2020, CMS rolled out Principal Care Management (PCM). 

What is Chronic Care Management?
CMS defines CCM as care coordination services done outside of the regular office visit for patients with two or more chronic conditions that are expected to last at least 12 months or until the death of the patient. In addition, these conditions need to place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.

You can bill for CCM when a physician or qualified health care professional directs your staff to spend at least 20 minutes of non-face-to-face clinical time treating the patient per calendar month.

CMS distinguishes between complex and non-complex care. The key differences between them are the:

• Amount of clinical staff service time provided
• The Involvement and work of the billing practitioner
• And The extent of care planning performed

Wondering how much you can increase your revenue by?

Currently CMS reimburses $42.00 for providing a minimum of 20 minutes of CCM per patient per month. Provide 60 minutes of CCM per patient per month and your practice will get $117.60. Let’s say you have a practice with100 CCM patients you could earn an additional $4,200-$11,760 per month for work you are likely doing anyway.

What is Principal Care Management (PCM)?

PCM is similar to CCM because both services are intended for patients requiring ongoing clinical monitoring and care coordination. One of the key differences, however, is that PCM only requires patients to have one complex chronic condition. 

There are 6 criteria for PCM:

• The condition is expected to last at least three months.
• The condition places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or death.
• The condition requires the development, monitoring, or revision of a disease-specific care plan.
• The condition requires frequent adjustments in medication regimens, and/or the management of this condition is unusually complex due to the patient’s comorbidities.
• The condition requires ongoing communication and care coordination between the relevant providers who are involved in the patient’s care.
• The condition requires at least 30 minutes of PCM services per calendar month.

To incorporate CCM and/or PCM into your practice, you will need to develop processes for implementation, tracking and billing. Tracking time and then using the appropriate codes is probably the most difficult part. You have to document the name of the staff member, the time spent, what they did specifically and their credentials.

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