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Principal Care Management

When chronically ill patients have complex needs, the ChronicCareIQ system helps you proactively stay engaged with patients in between visits and captures the data you need to keep them on track.

Prevent Disease Progression Among Your Patients with a Single Chronic Condition

While similar to CMS’ Chronic Care Management program, Principal Care Management (PCM) reimburses medical professionals, typically specialists, for the care management services they provide patients with a single, high-risk disease.

With ChronicCareIQ, specialists such as cardiologists or neurologists now have the opportunity to manage their patient’s disease-specific condition(s) while removing the burden of managing additional chronic conditions the patients have that are not relevant to the physician’s specialty.

The Benefits of PCM

  • Give patients a sense of self-control and confidence as they navigate their complex condition
  • Prevent hospitalizations and disease progression
  • Demonstrate your ability to consistently improve patient outcomes and contain costs
  • Continuously improve patient satisfaction and stickiness
  • Generate revenue for the work you are already doing
  • Gain visibility into clinical and financial operations for smarter business decisions

“ChronicCareIQ is simple to use and gives you the data you need to make the right decisions to care for your patients. It has also helped us improve the quality of care we provide our patients and minimize hospitalizations.”

Krishna Gaddam, MD, Heart South Cardiovascular Group

How it works

How ChronicCareIQ Enables Specialists to Build Robust PCM Programs

  1. Once patients are enrolled in your care management program, the system begins to proactively engage with them according to the clinical protocols you set for their specific chronic conditions. Engagement comes in the form of a series of simple questions that patients respond to – either on their phone, tablet, or personal computer.
  2. As your team provides care and supportive services, such as phone calls,  coordinating medication refills, and speaking with specialists, the system recognizes those interactions and automatically captures and timestamps each activity. Each eligible activity is then assigned the appropriate care management program codes. There is no need for staff to manually provide documentation or follow reimbursement guidelines for hitting certain thresholds – the system does the work for them.
  3. Your clinical team members simply review their red-yellow-green dashboards to know which patients are at risk for falling out of the guidelines you’ve set and which ones need immediate attention. They can drill down to the details of each patient, review recent interactions and see the latest data coming in from patients and/or monitoring devices. This gives them a complete picture of the patient in real-time so they can make more informed decisions about what needs to happen for each patient.
  4. Your back-office staff has access to reports that show which clinical activities were performed on which patients so preparing claims for reimbursement is simple. The system even tells them how close each enrolled patient is to fulfilling the respective CCM requirements each month.

Principal Care Management CPT Billing Codes (as of CMS FY2022 Fee Schedule)

In 2022, four new PCM codes replace the two previous PCM codes (HCPCS codes G2064 and G2065):

  • CPT code 99424: PCM services for a single high-risk disease first 30 minutes provided personally by a physician or other qualified health care professional, per calendar month
  • CPT code 99425: PCM services for a single high-risk disease each additional 30 minutes provided personally by a physician or other qualified health care professional, per calendar month
  • CPT code 99426: PCM, for a single high-risk disease first 30 minutes of clinical staff time directed by physician or other qualified health care professional, per calendar month
  • CPT code 99427: PCM services, for a single high-risk disease each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month

Hear What Our Customers are Saying