12 min
Add Chronic Care Management (CCM) and Principal Care Management (PCM) To Your Practice The Private Medical Practice Academy
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- Entrepreneurship
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 providedThe Involvement and work of the billing practitionerAnd The extent of care planning performedWondering 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 regimeWant to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com
Join my FB group, The Private Medical Practice Academy.
Enroll in How To Start Your Own Practice and get the step-by-step process for opening your practice.
Join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice. The course, How To Start Your Own Practice is included in the membership, as a bonus.
Rate, Review, & Follow on Apple Podcasts"I love Sandy Weitz and The Private Medical Practice Academy Podcast." -- If that sounds like you, please consider rating and reviewing my show! This helps me support more people -- just like you -- move toward the practice they want . Click here, scroll to the bottom, tap to rate with five stars, and select “Write a Review.” Then be sure to let me know what you loved most about the episode!
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 providedThe Involvement and work of the billing practitionerAnd The extent of care planning performedWondering 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 regimeWant to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com
Join my FB group, The Private Medical Practice Academy.
Enroll in How To Start Your Own Practice and get the step-by-step process for opening your practice.
Join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice. The course, How To Start Your Own Practice is included in the membership, as a bonus.
Rate, Review, & Follow on Apple Podcasts"I love Sandy Weitz and The Private Medical Practice Academy Podcast." -- If that sounds like you, please consider rating and reviewing my show! This helps me support more people -- just like you -- move toward the practice they want . Click here, scroll to the bottom, tap to rate with five stars, and select “Write a Review.” Then be sure to let me know what you loved most about the episode!
12 min