Principal Care Management
A New 2020 Medicare Service
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PCM Overview
Who benefits?
Patients with one high-risk or complex condition expected to last 3 months or longer. It allows the practice to receive compensation for providing comprehensive care to patients.
What services count towards the 30 minutes?
Phone calls, updating the care plan, emails, portal messages, discussing the case with other providers, overseeing transitions of care relative to your specialty and other activities.
What is needed?
Patients with one high-risk or complex condition expected to last 3 months or longer. It allows the practice to receive compensation for providing comprehensive care to patients.
Why consider it now?
Many specialty practices are experiencing reductions in patient volumes due to the public health emergency. Physicians and mid-level providers can perform these services from any remote location.
Reimbursement
If provided by physician: $85 per month (per patient)
If provided by clinical staff members: $40 per month (per patient)
What is the revenue potential for PCM services?
10 hours per week of PCM services provided by a physician, NP, PA or CNS could generate more than $5,000 per month in needed revenue.
PCM by Specialty
Cardiology
PCM services are well-suited for cardiology, as many disorders managed by cardiologists meet the criteria for a high risk or high complexity conditions.
Neurology
Neurologists manage a number of conditions that would qualify for PCM services, including cerebrovascular conditions, myasthenia gravis, some forms of multiple sclerosis, and others.
Nephrology
Many of the conditions managed by nephrologists, in particular the more advanced stages of chronic kidney disease, easily meet the criteria for PCM services.
Gastroenterology
Gastroenterologists manage patients with Crohn’s disease, ulcerative colitis, hepatitis, and other conditions that qualify for PCM services.
Pulmonary Medicine
Patients with emphysema and other forms of COPD, brittle asthmatics, and other conditions qualify for PCM services.
Rheumatology
PCM is optimal for rheumatologists given the number of patients they manage that have a high-risk and/or complex condition.
Oncology
A large number of oncological conditions meet PCM requirements, making PCM well-suited for this specialty.
Endocrinology
Endocrinologists manage a high percentage of patients with high-risk and complex conditions.
Internal Medicine
Internists often manage patients with one high-risk and/or complex condition.
Family Medicine
Family physicians frequently manage patients with a single high-risk and/or complex condition, making them eligible to provide PCM services.
Geriatric Medicine
PCM is optimal for geriatricians as they often manage patients with a single high-risk and/or complex condition.
Other Specialties
Clinicians that manage or co-manage a single high-risk or complex condition can provide PCM services, regardless of specialty.
Explore PCM in More Detail
PCM expands your ability to provide comprehensive care while generating a unique and signifcant new source of revenue.
Please visit our PCM summary page for more detailed information, including how to contact us for a free PCM detailed summary document.
The only current source of official information on PCM services is in the 2020 Medicare Physician Fee Schedule Final Rule.
To provide quick access to the resource, the section of the 2020 final rule on PCM services has been reproduced here.
As additional information becomes available we will update this website.
For questions please contact us at info@apollohit.com