Prevounce Blog

An Ounce of Prevention

Medicare’s New 2020 Chronic Care Service: Principal Care Management

Read More
Medicare chronic care service

Medicare’s New 2020 Chronic Care Service: Principal Care Management

by Amanda Martin

CMS recently finalized its Medicare coverage changes for 2020 and we’ve found a little something to be excited about. Officially dubbed Principal Care Management (PCM), this new program will allow medical providers to bill Medicare for providing care management services to beneficiaries who have only one high-risk qualifying condition or diagnosis.

If your practice is already providing Medicare beneficiaries with Chronic Care Management (CCM), this new program should be fairly easy to implement and incorporate into your existing care management program. Because PCM eligible patients only need to have a single serious chronic condition to qualify, the reach of this new program will be significant and open-up care opportunities for more patients while increasing revenue-generating opportunities for your practice. 

Principal Care Management in a Nutshell

Medicare released two new HCPCS codes that can now be used to bill for PCM services:

  • G2064: For at least 30 minutes of provider/physician time per calendar month. This code may be used by a physician, nurse practitioner, or physician assistant. ($92.03 Average Reimbursement)
  • G2065: For at least 30 minutes of clinical staff time billed once per calendar month. ($39.70 Average Reimbursement)

Additionally, to bill for PCM services the following requirements must be met:

  • The patient must have one qualifying chronic condition expected to last between three to 12 months or until death.
  • The condition has resulted in hospitalization and/or puts the patient at an increased risk of hospitalization, or the condition significantly increases the risk of functional decline or death.

PCM services may not be billed with other care management codes such as CCM (CPT’s 99490, 99491, 99487, 99489) for the same patient in the same month. Also notable, CMS has not placed any restrictions on who may perform PCM services meaning specialty providers are also eligible to participate.

The Takeaway On Principal Care Management

Medicare is quickly recognizing the value in effectively managing their beneficiary’s chronic health conditions and is incentivizing providers in hopes that they will find cost-effective ways to provide care management services. While PCM and CCM are similar in design, PCM differs because patients only need to have one qualifying chronic condition instead of two. PCM also differs from CCM in how the patient’s care plan is developed.

When creating the care plan for a patient enrolled in PCM, the focus must be on the specific disease or chronic condition whereas the care plan for CCM is much broader in scope. When documenting PCM services, the billing provider also needs to be mindful that they are responsible for documenting all the patient’s care for the condition being managed, including any care received from outside providers.   

PCM will be a game-changer for reaching patients with a single chronic condition making it easier for you to manage their care and receive the compensation you deserve. You can now receive reimbursements for the time you spend on complicated cases where medications and care plans change frequently, providing a focus on managing the condition before it increases the patient’s risk for hospitalization. 

If you’re not sure how to implement this exciting new revenue-generating opportunity into your existing care management program, Prevounce can help.  Our intelligent programs incorporate the tools you need to build your care management program to Medicare specifications, ultimately resulting in healthier patients and increased reimbursements for your practice.  

Prepare for MACRA and MIPS in 2020

All Posts

Related Posts

CMS Rules for Remote Patient Monitoring in 2020: What You Need to Know

Whether your practice is already delivering or is planning to deliver RPM services to Medicare and/or Medicaid patients this year, you must understand the CMS rules for remote patient monitoring services in 2020. Without this knowledge, you run the risk of not getting paid appropriately for remote patient monitoring by CMS (Centers for Medicare & Medicaid Services) and possibly running afoul of requirements that can jeopardize your reimbursement and lead to regulatory headaches. To help ensure you receive appropriate and timely payments for remote patient monitoring from CMS and avoid legal scrutiny for RPM services, here are three key things to know. 

Prevounce Launches Annual Preventive Health Scholarship Program

Prevounce Health, creators of the Prevounce Care Coordination Platform, announces the launch of an annual undergraduate and graduate scholarship program.

16 Remote Patient Monitoring Statistics Every Practice Should Know

Is your practice looking to help your patients stay healthy and reduce their expenses while generating consistent revenue? Then you're going to want to strongly consider providing remote patient monitoring services. Remote patient monitoring, or RPM, is a form of virtual care technology that is receiving tremendous attention and increased adoption during the COVID-19 pandemic, and rightfully so. Remote patient monitoring allows healthcare providers to monitor and electronically capture medical and other health data from patients for assessment, recommendations, and instructions. As a virtual care technology, this collection of health data, which can include blood pressure, vital signs, weight, heart rate, and blood sugar levels, can occur anywhere but the practice. As long as patients are not in a shared space with the healthcare provider delivering the remote patient monitoring services, they can receive these services. This means a patient can be in their home, in an office, on vacation, in a skilled nursing facility, or any other location. Remote patient monitoring is lucrative for practices, being embraced by patients and payers, and likely to play a significant role in the delivery of healthcare going forward — something these RPM, virtual care, and telehealth stats prove all too well. Note: We’ll be regularly adding new statistics to this resource, so bookmark the page and check back regularly!