Healtharc

A Strategic Benefit of Principal Care Management PCM ( Principal Care Management) is designed specifically for patients with single high-risk chronic conditions—offering reimbursement for PCM is healthcare's latest opportunity. Principal Care Management is much more focused compared to mid-level chronic care management programs because it directly allocates clinical and administrative resources to patients’ core health issues. As a result, PCM builds stronger therapeutic alliances, improves reimbursement for focused and precise interventions, and yields more clinical and financial value. PCM CPT Codes with Payment Boundaries PCM reimbursement is based on traditional chronic care management codes, along with more recent billing features centered on principal care, including: G0511 – Principal Care Management. It is reimbursed about $85-95 for every single patient each month, and it requires at least 30 minutes of care management service related to singular, high-risk chronic issue...

The Untapped $4 Billion Opportunity from CCM Chronic Care Management is healthcare’s most hidden reimbursement risk, and Medicare spends over $4 billion a year on CCM services. Even with this massive expenditure, well under 20% of eligible Medicare beneficiaries receive advanced chronic care management services. With a deep understanding of reimbursement mechanisms and systematically designed service delivery programs, this gap presents exceptional opportunities for providers. Comprehensive CCM CPT Code Framework Chronic Care Management has multiple reimbursement pathways designed to support varying service complexity and patient needs: 99490 - Basic CCM Services: Reimbursing $65-75 per patient per month for the most basic services. Care management time is capped at 20 minutes. This service needs 24/7 care team access, and proactive engagement at scale for patients with two or more chronic conditions. 99491 - Extended CCM Services: Each additional 20 minutes will be reimbursed $50-60...

Principal Care Management (PCM) and Transitional Care Management (TCM) are two Medicare programs that focus on enhancing patient care while simultaneously presenting an opportunity for providers to maximize their return on investment (ROI). Funds are disbursed to practices that enhance patient engagement and care efficiency while simultaneously minimizing costs and utilizing PCM for managing chronic conditions and TCM for care transitions post discharge. This article reflects on ROI steering reasons alongside an illustrative example with hypothetical figures to aid providers on using these programs to their maximum potential.  PCM and TCM Overview PCM is applicable and best suited for patients with one chronic condition with a severe form of a single chronic health condition (e.g., advanced hypertension) for a duration of three months. The condition must be debilitating and requires substantial management. It also requires careful and continuous monitoring. -Remote patient monito...