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 13, 2023

New s

- Hospital Outpatient Prospective Payment System: Remedy for the 340B-Acquired Drug Payment Policy for Calendar Years 2018-2022

- National Coverage Determination: Pre-exposure Prophylaxis Using Antiretroviral Drugs to Prevent HIVInfection

- Medicare Dental Services: Learn What?s Covered

Claim s, Pricers, & Codes

- Institutional Providers: Resubmit Audiology Claims Returned with Reason Code 34963

- Inpatient Prospective Payment System-Excluded Hospitals: Correcting Issue with Excluded Units

- ICD-10-CM Diagnosis Codes: FY2024 Coding Guidelines & Conversion Table

Event s

- Expanded Home Health Value-Based Purchasing Model: Overview of the Interim Performance Report Webcast ? July 27

MLN Mat t ers®Art icles

- ICD-10 & Other Coding Revisions to Laboratory National Coverage Determinations: October 2023 Update

- Ambulatory Surgical Center Payment System: July 2023 Update ? Revised

- New Fiscal Intermediary Shared System Edit to Validate Attending Provider NPI ? Revised

Publicat ions & Mult im edia

- Period of Enhanced Oversight for New Hospices in Arizona, California, Nevada, & Texas

- Expanded Home Health Value-Based Purchasing Model: New Resources