How Can Physicians provide PCM Effectively

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How Can Physicians provide PCM Effectively?
With effect from 2022, Medicare stopped using two Healthcare Common Procedure
Coding System G codes and started accepting four new CPT codes for principal care
management (PCM) – CPT Code: G2064 and CPT Code: G2065. According to experts,
the new codes give doctors the chance to increase outcomes while also increasing their
earnings because they are paid at a greater rate than the G codes.
In that both services are provided to patients who need continuous clinical monitoring
and care coordination, PCM and chronic care management (CCM) are comparable. To be
eligible for PCM, patients must only have one complicated chronic condition, as opposed
to three or more for CCM, which is the opposite of PCM.

How Will PCM Affect Healthcare Industry?
Practitioners may now be compensated for giving their patients care
management solutions that are more focused within their own specific area of
specialty thanks to the new PCM codes. A patient’s primary care doctor may
nevertheless offer more comprehensive care management services as necessary.
The new PCM codes, like the CCM codes, may be used in conjunction with
Remote Patient Monitoring codes (CPT Codes 99453, 99454, 99457, and 99091),
and they may be used incidentally by a billing practitioner while being overseen
by the clinical personnel performing the services.

Learn About the Principal Care Management
Billing Criteria
Patients must have one complex chronic disease that satisfies all six of the following
requirements in order to be eligible for principal care management (PCM) billing.
1. Should persist for at least three months.
2. Significantly increases the patient’s risk of hospitalization, acute decompensation or
aggravation, functional decline, or even death.
3. Needs a care plan that is particular to the disease to be developed, monitored, or
revised.
4. Requires frequent modifications to drug schedules, and/or the condition’s care is
extremely difficult because of other conditions.
5. Demands constant contact and care coordination amongst pertinent healthcare
providers.
6. Requires PCM services for at least 30 minutes each calendar month.

Benefits of PCM
1. Stabilization of Chronic Condition: One of the main objectives of PCM is to
stabilise a patient’s chronic condition as soon as feasible so that the patient’s primary
care physician can take over overall responsibility for their treatment. The patient
would pay far less for healthcare as a result.
2. Preventing Secondary Chronic Condition – The benefit of treating a chronic
ailment as soon as it manifests is that it significantly lowers the likelihood of a new,
secondary chronic condition developing. The care and attention that patients receive
from their healthcare professional is one overarching benefit of all of CMS’s
initiatives.
3. Opportunities for Reimbursement – CMS enables providers to get PCM
reimbursements, providing your practice with an extra source of income.

How Can Physicians Provide PCM Effectively?
Patient Selection – PCM is not necessary for all individuals with complex chronic
conditions. Be sure to note that the patient’s condition is so severe that
hospitalisation is either imminent or that the patient has already received multiple
hospitalisations as a result of the disease.
Patient Consent – Document the patient’s consent, and make sure to note that
you’ve informed them that their coinsurance is in effect.
Bill Correctly – Report CPT codes 99424 and 99425 if a physician or non-
physician performs the PCM, and record CPT codes 99426 and 99427 if a clinical staff
member or other certified professional supervises the service directly.
Outsource PCM Services – Identify the PCM service types you are presently
offering, but not charging. Do you have the ability to charge for those services in order
to maybe defray the expense of recruiting a new employee who may also be qualified
to offer CCM and TCM services? Outsourcing your services to a third party is also a
beneficial option. You can opt for an offshore medical billing agency to assist you with
your PCM services that can assist generate more revenue with minimal errors.

Maximize Collections and Improve Patient
Care with ICS Services
CMS enables providers to increase revenue streams and enhance patient outcomes
through PCM. You may manage your patients more effectively by using our PCM solution,
which has many of the same features and resources as our CCM solution. In order to
increase your revenue and guarantee patient happiness, ICS, an offshore medical billing
company, offers its expertise with patient care enrolment and consent forms, plan
assessments, and monthly PCM time tracking.

About Us
We at Info Hub Consultancy Services (ICS), a leading medical billing
company in India offer medical billing solutions to healthcare organizations,
physicians, medical institutions, and groups. Our revenue management
cycle helps in reducing operational expenses and increasing the overall
revenue.
Info Hub Consultancy Services (ICS) was founded in 2010 and is now one of
the leading service providers of highly motivated, certified coders, and
billers in the US medical billing industry.

Contact Us
Info Hub Consultancy (ICS) Services Pvt. Ltd.
Sf No 558/2, Udayampalyam Rd,
Nava India, Coimbatore,
Tamil Nadu 641028
Tel:+1 (888) 694-8634 / +91 829-745-6441
Email - inquiry@infohubconsultancy.com

How Can Physicians provide PCM Effectively

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