Underutilized Remote Care Services: Chronic Care Management (CCM) and Principal Care Management (PCM)

Date: Wednesday May 27, 2020

10:00 AM PDT | 01:00 PM EDT

Duration: 60 Minutes
Instructor: Michael Stearns
Webinar Id: 802004
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This presentation will review in detail the requirements for CCM and PCM services and their potential levels of reimbursement. It will also review how to implement these services, and how to avoid potential pitfalls.


Medicare launched the Chronic Care Management (CCM) services initiative in 2015.

This program is designed to reimburse clinical practices for the time spent providing non-face-to-face care to patients with 2 or more chronic medical conditions, maintaining a comprehensive care plan, and meeting other requirements

The service is oriented towards primary care providers, but other specialties may offer these services if they are managing all the patient’s medical conditions. CCM has proven value (as per CMS) in improving the quality of care provided patients and reducing the overall cost of care.

There are several reimbursable codes associated with CCM services. Medicare will pay between $41 and $120 (or more) per month depending on the types of CCM services provided. CCM services may be provided during the same month as telehealth visits, transitional care management and other services.

CMS has temporarily lifted some of the requirements for CCM, making now a good time to explore offering the services to your patients. This program has been underutilized in the past, but represents an opportunity for practices to provide care and create new revenue streams during and after the current pandemic.

Medicare also approved reimbursement for a new program in 2020 referred to as Principal Care Management (PCM) services. This program is similar to CCM but reimburses specialists for the non-face-to-face care they provide to patients with one or more chronic conditions.

This presentation will review in detail the requirements for CCM and PCM services and their potential levels of reimbursement. It will also review how to implement these services, and how to avoid potential pitfalls.

Why you should Attend: During the current pandemic practices are shifting away from face-to-face care, including telehealth and remote physiologic monitoring. However, CCM and PCM can be provided and billed for during the same month as telehealth visits. These initiatives represent optimal ways to capture revenue while providing enhanced care to patients. A practice that cares for Medicare patients would be well advised to gain understanding of CCM and/or PCM services and consider them for their organization.

Areas Covered in the Session:

  • Understand requirements for CCM
  • Understand requirements for PCM
  • Understand the reimbursement potential of CCM
  • Understand the reimbursement potential of PCM
  • Understand how these services may be billed simultaneously during the same calendar month

Who Will Benefit:
  • Physician office Practices
  • Auditors
  • Health Information Management Professionals
  • Coding Professionals
  • Chief Medical Officers
  • Chief Financial Officers of Hospitals
  • Healthcare Executives
  • Practice Managers
  • Physicians
  • Clinicians
  • Compliance Professionals

Speaker Profile
Michael Stearns, MD, CPC, CFPC, is a physician informaticist, certified professional coder (CPC), certified family practice coder (CFPC). He is the CEO and Founder of Apollo HIT, LLC, an Austin-based company that provides consulting services in the areas of healthcare information technology and compliance. His company assists organizations with meeting their documentation, coding, EHR optimization and program goals, including their performance in the Merit-based Incentive Payment System and Alternative Payment Models.

During his career Dr. Stearns has received several awards for teaching and contributions to patient safety and patient privacy initiatives. He played a central role in the design and development of vocabularies at the National Institutes of Health (NIH) and provided a leadership to the development of the Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT). He has served in a leadership capacity for two leading EHR vendors and as an advisor to several emerging HIT organizations.

He is a cofounder and lecturer at the University of Texas at Austin Health Information Technology Certificate Program, a nationally recognized model for HIT workforce development. He has been invited to testify in Washington, D.C. before federally sponsored HIT policy and standards organizations on five separate occasions. He served as the founding board president of the Texas eHealth Alliance, an organization that provides stakeholder input related to health information technology policy matters to state legislators. He is also an accomplished author and lecturer on a range of health care quality, health information technology, coding/compliance and quality-based performance initiatives.

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