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Designed for doctors, often specialists, whose patients have a specific condition which requires additional management and/or monitoring.
While similar to CMS’s Chronic Care Management program, Principal Care Management (PCM) reimburses medical professionals, typically specialists, for the care management services they provide to patients with a single, high-risk condition.
Specialties include:
"ChronicCareIQ has helped tremendously in keeping in touch with our patients on a constant and recurrent basis. It has also helped us improve our quality scores, decrease our emergency room utilization, and also decrease hospitalizations."
Once patients are enrolled in your care management program, the system begins to proactively engage with them according to the clinical protocols you set for their specific chronic conditions. Engagement comes in the form of a series of simple questions that patients respond to – either on their phone, tablet, or personal computer.
As your team provides care and supportive services, such as phone calls, coordinating medication refills, and speaking with specialists, the system recognizes those interactions and automatically captures and timestamps each activity. Each eligible activity is then assigned the appropriate care management program codes. There is no need for staff to manually provide documentation or follow reimbursement guidelines for hitting certain thresholds – the system does the work for them.
Your clinical team members simply review their red-yellow-green dashboards to know which patients are at risk for falling out of the guidelines you’ve set and which ones need immediate attention. They can drill down to the details of each patient, review recent interactions and see the latest data coming in from patients and/or monitoring devices. This gives them a complete picture of the patient in real-time so they can make more informed decisions about what needs to happen for each patient.
Your back-office staff has access to reports that show which clinical activities were performed on which patients so preparing claims for reimbursement is simple. The system even tells them how close each enrolled patient is to fulfilling the respective CCM requirements each month.
CPT code 99424 – $81 WORK RVU – 1.45
Principal care management services for a single high-risk disease, at least 30 minutes of physician or other qualified healthcare professional time per calendar month requiring the following elements:
CPT code 99425 – $58 WORK RVU – 1.00
Principal care management services, each additional 30 minutes of physician or other qualified health care professional time per calendar month. Limit to two instances per calendar month. (List separately in addition to code for primary procedure)
CPT code 99426 – $60 WORK RVU – 1.00
Principal care management services for a single high-risk disease, at least 30 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month, requiring the following elements:
CPT code 99427 – $46 WORK RVU – 0.71
Principal care management services for a single high-risk disease, each additional 30 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month. Limit to two instances per calendar month. (List separately in addition to code for primary procedure)
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