TRANSITIONAL, REMOTE, CHRONICCARE&PRINCIPAL CARE

- Patient Education and Self-Management Support:

PCM services emphasize patient education and self-management support to empower patients in managing their health conditions This component includes providing education on medication adherence, lifestyle modifications, symptom management, and self-monitoring techniques. By equipping patients with the knowledge and skills to actively participate in their own care, PCM services promote better health outcomes and improved quality of life

- Care Plan Development and Review:

PCM services involve the development and regular review of a comprehensive care plan tailored to the patient's specific needs and goals. The care plan includes a summary of the patient's health conditions, treatment goals, medication list, and recommended interventions. Regular review and updates to the care plan ensure that it remains relevant and aligned with the patient's evolving healthcare needs.

- Medication Management:

Effective medication management is a critical aspect of patient care management PCM services include medication reconciliation, assessment of medication adherence, monitoring for potential drug interactions or side effects, and providing education to patients on proper medication use. Optimizing medication regimens improves patient safety, reduces adverse events, and enhances treatment effectiveness

- Consent:

Obtain written consent from the patient for PCM services, explaining the scope and nature of the services, as well as any associated cost-sharing requirements.

Billingand CodingConsiderationsfor PCM:

- Eligibility: PCM services are typically eligible for reimbursement from Medicare and some private payers. Ensure that the patient meets the specific eligibility criteria defined by the payer, which may include having chronic conditions that require ongoing care management.

- Time-Based Billing: PCM services are billed based on the total time spent on care management activities during a calendar month. This includes both the time spent by clinical staff and the physician or other qualified healthcare professional PCM services require a minimum of 30 minutes before billing. See CorroHealth TCM, CCM, RPM, PCM Table for more information.

- Documentation: Accurate and detailed documentation is crucial to support the medical necessity of PCM services. Document the time spent on care management activities, care coordination efforts, patient education, medication management, and care plan development or review.

- Reporting Services:

- 99497 (advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate) is a stand-alone billable RHCvisit

- Shared or Incident-to-Billing: When performed in a clinic setting, some PCM services may be billed under the supervising physician or as incident-to-services Understand the billing guidelines applicable to the practice and ensure compliance with the relevant regulations

CorroHealt h invit es you t o check out t he m lnconnect s page available from t he Cent ers For Medicare and Medicaid (CMS). It 's chock full of new s and inform at ion, t raining opport unit ies, event s and m ore! Each w eek PARA w ill bring you t he lat est new s and links t o available resources. Click each link for t he PDF!

Thursday, July 6, 2023

New s

- CY2024 Home Health Prospective Payment System Proposed Rule

- HHSAnnounces Actions to Lower Health Care Costs and Allow Medicare to Negotiate Lower Drug Prices

- CMSRoundup (June 30, 2023)

- Skilled Nursing Facility: COVID-19 Enforcement Discretion for Pharmacy

Billing Ended June 30

- Medicare Providers: Deadlines for Joining an Accountable Care Organization

- Help People with Disabilities Get the Care They Need

MLN Mat t ers®Art icles

- Corrections to Home Health Claims Edits

Publicat ions

-

Medicare & Mental Health Coverage ? Revised

From Our Federal Part ners

- Wildfire Smoke Exposure Poses Threat to At-Risk Populations