Simplify Principal Care for High Risk Chronic Condition

Chronic Care Management (CCM) was a program started by CMS in 2015 to reduce the financial burden of patients and the workload of providers. It was started after recognizing the rising multiple chronic conditions in patients. However, in 2020, CMS recognized that the number of patients suffering from a single, high-risk chronic condition is also increasing. To address this, the CMS started the PCM Program and that is the major difference. While CCM focuses on patients with two or more chronic conditions requiring ongoing care, PCM focuses on one complex illness requiring intensive care.

There are certain criteria set by the CMS for patients to be eligible for the Principal Care Management Program. The obvious one is that the patient should have a single complex chronic condition, which is expected to last for at least three months. Along with that, the condition should have a high-risk factor of hospitalization, functional decline, or even death. It requires a disease-specific care plan, potential medication adjustments, and complex management, often due to comorbidities.

The key benefits of Principal Care Management (PCM) for healthcare providers include:

1. Improved patient outcomes: Better patient care management as the focus is on single, high-risk chronic conditions.
2. Increased revenue: The care management services serve as an additional source of income for providers.
3. Enhanced care coordination: Since the focus is on managing a single chronic condition, it leads to better communication and collaboration to improve patient engagement.
4. Preventative care: Early intervention helps to prevent the development of further complications.

eCareMD is designed to help healthcare organizations by ensuring accurate and consistent product data across all of their platforms and practices. This improves patient safety, simplifies clinical workflows, streamlines supply chain operations, and facilitates regulatory compliance by providing a single source of truth for medical product information.

Billing Codes for PCM

1. CPT 99424 30 minutes of providers service per month
2. CPT 99425 Additional 30 minutes of providers services per month
3. CPT 99426 30 minutes of clinician service per month
4. CPT 99427 Additional 30 minutes of clinician service per month

Yes, PCM (Principal Care Management) services can be effectively provided via telehealth. eCareMD's Telehealth integration facilitates remote patient monitoring, medication management, and communication between healthcare providers and patients. This allows for ongoing care coordination and management of chronic conditions, crucial elements of PCM, to be delivered remotely.

eCareMD adheres to Medicare guidelines by automatically and accurately documenting patient interactions, care plans, and time spent. It ensures qualified staff deliver services, maintains accurate records for audits, and aligns with specific CPT codes for appropriate billing, particularly for Chronic Care Management (CCM) and similar programs.

PCM (Principal Care Management) services can be provided by various healthcare professionals, including:

1. Physicians.
2. Physician Assistants.
3. Nurse Practitioners.
4. Certified Nurse Midwives.
5. Clinical Nurse Specialists.

Additionally, clinical staff under the direction of these professionals can also deliver aspects of PCM services. These services can be offered within physician offices, Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and Critical Access Hospitals (CAHs).

Principal Care Management (PCM) enhances patient care by providing focused, coordinated management of a single complex chronic condition. This leads to:

1. Improved outcomes: By emphasizing personalized care plans and proactive monitoring.
2. Enhanced coordination: Through better communication among healthcare providers.
3. Increased engagement: Through patient education and active participation in their care.
4. Reduction of complications: Through diligent monitoring and preventative care.

To begin PCM (Patient Care Management) with eCareMD, your healthcare practice should:

1. Align eCareMD with your practice's needs.
2. Integrate eCareMD with existing EHR systems for seamless data flow.
3. Train staff on the eCareMD's functionalities for effective utilization.
4. Begin by enrolling patients who would benefit from PCM services.
5. Begin using the eCareMD to track and manage their care.

Our PCM product prioritizes data security and HIPAA compliance through:

1. Encryption of protected health information (PHI) both in transit and at rest.
2. Strict access controls and user authentication.
3. Regular security risk assessments and audits.
4. Implementation of administrative, physical, and technical safeguards as mandated by HIPAA.
5. Business associate agreements with any third party that handles PHI.