Principal Care Management

Table of Contents:

• Eligibility Rules
• CPT Rates
• Consent
• Add PCM
• Clinical Time Logging
• Approve Time
• Due Reminders

Eligibility Rules:

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• At least one chronic condition must have existed for the previous 90 days.

CPT Rates:

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• There are two CPT codes for PCM.
• The following are the details for these CPT codes, including their applicable rates.

Instructions:

• Click the PCM tab on the patient dashboard.
• As shown, an accordion is located at the top of the page. You may expand or collapse it as needed. By default, the patient details accordion is set to closed.

• Once the expand button has been clicked, you will be able to view the Expanded Patient Details, as shown below.

• On the left side, you will also notice a call icon next to the Mobile number. This icon is used to place a call to the patient on their cell phone.

1. Click “Add PCM episode” to open the “Consent” tab.
2. On the left side, you will see three sub-tabs. They include the following sections:
   • Consent
   • Care Plan
   • Activit
3. with Clinical Timer at the top of the sub-tabs.

Consent:

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• If the patient agrees to take PCM service, click on "Accepted by patient" and submit.

• The consent can be viewed in two languages: English and Spanish.
• By default, English is selected. Below is the consent screen in Spanish.

• You may select the consent date and time manually for previous dates; however, there are restrictions for future dates and times. By default, the current date and time are displayed.

• You can upload an attachment file that must be under 5 MB in size.

• If the patient disagrees, then click on "Rejected by patient" and submit. This can be later edited.
• Until you accept the content you can not navigate to the Care Plan sub tab.

• 7. Accept consent and click on “Next” to enter “Chronic Diseases” tab.

• At the bottom, you can review the consent details, including where the consent was given and the time it was recorded.
• When you click Next, you will be taken to the next sub-tab, the Care plan tab.

Care Plan:

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You will see a wizard at the top, which has the following sections:

• Health & Risk Assessment
• Problem List
• Medications
• Care Questionnaire
• Findings & Goals
• Intervention & Monitoring Plan
• Other Details

After selecting the Care Plan sub-tab, you will be directed to the Health & Risk Assessment wizard.

• You will be presented with a list of questions, and you must select one answer for each question. To respond to additional questions, please scroll to the bottom of the page.
• Once you have answered a question, click the Save changes button.

• After saving the changes, click on the Next button to navigate. Alternatively, you can navigate through the wizard.

  
  
• After navigating to Problems List you will have Chronic Conditions, Allergies
• In the Problem list section, we have fields - Chronic conditions, Allergies To add data, you can see an add button beside their labels. On clicking the button, respective pop-up appears.
• Search the condition on clicking the Search button and Fill the other details and click on Add button in Chronic Care Problem, Surgeries and Test/Procedures Pop-ups.

• To edit the data, please hover over the input field to view the Edit and Delete options. Click the Edit button to open the corresponding pop-up, make the changes you would like to apply, and then click the Update button. After you have updated the diagnosis, click the Next button to proceed to the Medications section.

• You can review the list of Active Medications that have been prescribed for the patient. From here, you may add, edit, activate, and inactivate medicines, as well as delete medications as needed.

• To add medicines, click the "Add Medicine" button on the right. The Add Medication pop-up will appear. To enable a prescription expiry reminder, check the box and select one of the two options - Remind before 5 days or 10 days then click the "Add Prescription" button to save and add the prescription.

• To edit any medicine, click the corresponding Edit button. After you click the Edit button, the Update Prescription pop-up will appear. Make the changes you need and click the Update button to save them.
• To inactivate a medicine, switch the toggle to the OFF state. The medicine will be inactivated. To activate the medicine again, switch the toggle back to the ON state.
• Once you have made your changes in the Medications section, click the Next button. You will then be taken to the Care Questionnaire section.
• You will see a list of questionnaire questions. Each question will include either a Yes/No option or a text area, depending on the question type.
• To answer additional questions, scroll to the bottom of the page. This is a mandatory section. You can add a care plan by answering all of the questions in this section.

• Please click the Save & Continue button once you have completed your updates in the Questionnaire section. The Findings & Goals section will then appear.
• In this section, you will see a list of Findings questions, with a text area provided for each question. You will also be able to enter both short-term and long-term goals.
• To add a long-term or short-term goal, click the Add New button. The Add Goals pop-up will open, and it will include a text area for your goal. After you click Add, the goal will be reflected in the appropriate section.

• You may edit the goals by clicking the pencil icon on the goals card. Once you do this, a Goals pop-up will appear, where you can review your response, make any necessary updates, and save your changes.

• Click the Save & Continue button after you have made your changes in the Intervention & Monitoring Plan section. The Findings & Goals section will then appear.
• You will see two sections: Life Style Modifications and Emergency Plan. Each section includes a text area for you to respond to the questions. If you need to answer additional questions, scroll to the bottom.
• All questions in this section are mandatory. Some fields may already be pre-filled please review them and update them as needed. If you do not complete all required fields in this section, you will not be able to add a care plan.

• Please click the Save & Continue button once you have made your updates in the Findings & Goals section. After that, the Other Details section will appear.
• In this section, you will see questions with text areas. These fields are not mandatory to complete.

• The first section is a Notes section, where you can add notes.
• After you have made all the required changes, click the Add PCM Plan button so the care plan is added.

• You can now view two buttons: View Log History and View Summary below the wizard.

• In View Log History, you can see every log entry. For example, when a Program Coordinator/Provider makes updates or edits, the corresponding logs appear with the names, dates, and times of those changes. By selecting the button, you will open a pop-up where you can review the logs and download them in A4 format.

• In the Summary view, you can view the total PCM service summary, including the details for both 'From' and 'To'. The interface also provides an option to download the summary.

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Activity:

You can navigate to the Activity subtab to add an activity.

You can add an activity by clicking the Add activity button in the top-right corner. The Add activity pop-up will then appear.

• Service - The service name will be auto-populated based on the record you selected in Billings.
• CPT code: - Select the CPT code based on the billing type.

• Description - Based on the CPT code, you will receive a set of descriptors from which you can select.

  Note: If the desired descriptor is not available, scroll to the bottom of the dropdown, select the other option, and enter your desired descriptor.

• Provider - The provider’s name will be auto-populated based on the record you selected in Billings.
• Patient - The patient’s name will be auto-populated based on the record you selected in Billings.
• Date - The current date will be auto-populated.
• To From - Based on the CPT code, the time will be auto-populated.
• To Time - Based on the CPT code, the time will be auto-populated.
• Notes - Add a note that is related to the billing.

• Call Type - It will be pre-populated when you select the CPT code. It is also editable.

  Note: Activity can be added; however, it cannot be edited or deleted.

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PCM History:

Once the care plan has been submitted, you can view the PCM history in the RPM Label at the top right. By clicking on it, a small modal will open, where you can discontinue the service.

• When you click the Discontinue Service button, a pop-up will appear where you can enter the reason for discontinuing the service.

  

• Once it is discontinued You Can see the History then it is discontinue. And the complete PCM will be disabled You can only view. you can not edit any form or filed.

• When you click on the Resume service option, you must provide new consent.

• Once the consent has been submitted, the previous date will be automatically populated in all forms.

Clinical Time:

You can Add Clinical time bill from the clinical time clock which on the Top of content Sub Tab.

• After clicking on it, you will see a pop-up model as follows.

• Service - Service type will be auto-populated.
• Activity - Activity type will be auto-populated.
• Date - Select to which date you would like to be billed.
• From - select the from time.
• To - select the to time.
• Notes - Add a note that is related to the billing.

Now click on the add button. The bill will reflect in the Clinical Time Tab under Billing.

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Billing form Patient Listing

As shown in the above image, when you click on any service like (CCM, RPM, TCM, PCM, AWV) in the patient listing, it will show you the pop-up as follows.

If you select Yes, the timer will begin, billing time will start, and you will be taken to the selected service within the patient dashboard. If you select No, you will be directed to the corresponding service in the dashboard without initiating billing.

Billing Flow

• If you select the PCM service and then choose Yes to bill the time, you will be taken to the service with the billing timer ON. This action will disable the other services, because when you are billing for a specific service, you cannot navigate to other services such as PCM, TCM, RPM, or AWV.

• If you would like to stop billing, please click the STOP icon located at the top near the header, as shown below.

  

• Once you STOP billing, the other services will be enabled, and the bill will be reflected in the Clinical Time Billing activity section.

From Service:

• If you would like to initiate billing while you are in a specific service tab, you may begin billing directly by clicking the Start Billing icon at the top and then following the steps in the Billing flow.

• Please navigate to the Clinical Time tab. If you would like to bill the records listed in the Billing section, click the checkbox at the beginning of each record.

• You can find the "Add Bill" button in the top-right corner of the table. Click it to open the pop-up for adding a bill, as shown below.

• Service: The service name will be pre-populated based on the record you selected in the billings section.

  Note: If you select multiple records with different services, the selection will be categorized as "others."

• CPT code:  Select the CPT code based on the billing type.

• Description: Based on the CPT code, you will be provided with a set of descriptors from which you can make a selection.

  Note: If the desired descriptor is not available, scroll to the bottom of the dropdown, click on the other option, and enter your desired descriptor.

• Provider: The provider’s name will be pre-populated based on the record you selected in the billings section.
• Patient: The patient’s name will be pre-populated based on the record you selected in the billings section.
• From Date: This field will be pre-populated, and the date and time will be based on the oldest record selected.
• To Date: This field will be pre-populated, and the date and time will be based on the newest record selected.
• Notes: Add a note related to the billing.

• Call Type: This field will be pre-populated when you select the CPT code, and it is also editable.

  After clicking on Add, the billed records will be disabled. The bill will then be reflected in the billing tab.

To submit the bill, please click the Claims Tab to navigate to the Claims section.

• To view the Bills for PCM, please go to the Patient Dashboard and select the Billing tab. The following screen will be displayed.
• There are four sub-tabs TCM, CCM, RPM, PCM, AWV, and Others for billing logs related to each program.

1. Click the RPM, CCM, TCM, or Others tab to display a calls list. Each row will include a checkbox and the following details:

• CPT code
• Time
• From (Date & Time)
• To (Date & Time)
• Topic
• Summary
• Status
• Action

1. CPT codes vary by service type (e.g., RPM, CCM, TCM, and others). CPT codes for each reimbursement type are different.
2. Billing period: Use the From and To date range in the Billing period section to display calls within the selected dates.
3. Please click the PCM tab.

• Users can use the “Add Row” option to add a row to the provided list by entering the required details, including Billing Type, CPT Code, topic, Provider, Patient, Date, Start Time, End Time, Meeting Notes, and call type.

1. To edit the call details, click the Edit icon under Action. This allows the user to edit the selected row’s information, including the Billing type, CPT code, topic, date, provider, meeting notes, and call type.
2. Submitted bills cannot be edited.

1. Each reimbursement type tab have filters as shown:

• All - Shows all the PCM call logs
• New - Displays all the newly submitted calls/ bills and are represented by Blue Color
• Submitted - Displays all the submitted calls/ bills and are represented by Light Green Color
• Rejected - Displays all the rejected calls and are represented by Red color
• On-Hold - Displays the calls which are kept on-hold and are represented by Amber Color
• Approved - Displays all the approved calls and are represented by Green color

1. You can view 2 actions in the Action - Edit and Delete. All New/ Rejected bills will have these icons enabled.
2. Once the Bill is submitted/ kept on-hold and Approved, these icons will be disabled.
3. On clicking the Rejected calls/bills, User can view the Rejected reasons, which shows the date with rejected reason.

• we can also download the each bill document by clicking on the Download icon.

• we can also download the bulk bill document by clicking on the Download Supporting Documents Button

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Approve Time:

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• The call logs that are submitted are saved in the Billing Portal. Once the Admin logs in, they can view the screen shown below.
• By default, All Programs and All Providers are selected. You may adjust these options based on your preferences.

• On the dashboard, count for Patients enrolled, Patients billed, Bills accepted, Bills pending will be displayed.

• On the left-hand side, there is a table icon. Upon clicking on it, a pop-up will appear where you can select the required table columns, as shown below.

  

  

  
  
• There are 9 filters: Network, Center, Service, Provider, Claims Status, Payment Status, CTP Code, Duration, and Search Bills, which allow you to search bills for review.
• Users can filter the submitted billing list based on the bill status across four categories.
• Submitted Bills
• Bills on Hold
• Accepted Bills
• Rejected Bills
• Patients that qualify under the rules engine for the set of rules associated with the respective CPT code will be ready to be billed, while patients that do not qualify under those rules will be rejected by the rules engine.
• Users can also filter the submitted billing list based on the type of billing or product (All/RPM/CCM/RTM/TCM/PMPM).
• Click the Status filter, select the Submitted Bill option, then click the Program filter and select CCM. The following screen will be displayed.

• User can filter the submitted billing list based on the selected duration of Date from and Date to. We can view the bills based on the Duration type - Monthly, Quarterly & Custom. By default, we have Monthly selected.

  

• Users can filter the submitted billing list by provider name for the selected center.
• The search field is available on the dashboard to find the required data.
• Below the filters, the table is displayed with the following headers:
  • Checkbox — to select all records
  • Patient EMR ID
  • Patient Name
  • Date of Service — the date on which the service was provided
  • CPT Type — RPM/CCM/TCM/Other CPT code and topic
  • Note — meeting notes captured while scheduling
  • Provider Name
  • Bill details — Bill ID and the month, date, and year the billing was submitted
  • Actions — Approve / On Hold / Reject
• All submitted bills appear in the list in checkbox form. Users can select bulk actions to mark the selected bills as Approved or Rejected. Users can also download the bills by clicking the Download option.
• To submit the bills, select the checkbox and click Accept selected bills on the right. A pop-up will appear to confirm whether you want to accept the bill. Click Yes to accept the bill.

• You can also reject bulk bills by selecting the relevant records and clicking the "Reject selected claims" button. This button will be displayed in the header area once you select the bills. After you click the button, a pop-up window will appear prompting you to enter the reason for the rejection. Once you enter the reason, click Submit. The rejected bills will then be listed under Rejected Bills.

  
  

  

  
  

• You may perform actions—Approve, On Hold, or Reject—for individual calls. After the call log is approved, set to On Hold, or rejected, it will be categorized as Accepted, On Hold, or Rejected, respectively.

  

• If there are no calls logs, you will see an empty state showing No records found.

  

  
  
• Once the bills are accepted, you can view them by selecting Status as Accepted.
• To download the Bill report, select the checkbox for an individual record, or select the checkbox in the header to download the report for all records.
• You can download the report for any status, including All, Ready to bill, Submitted, On-Hold, Rejected, and Approved.

• You can view download option at the right, click on the download to download the report. You can view it in your downloads.

• We can also add the Billed Amount, Allowed Amount, Adjusted Amount, Balance Amount for each bill in the input field where you can enter the amount and click outside the field. It will be saved, but it is only for reference and will not be referenced anywhere else.

  

• We also provide the options Claim Denied, Claim Failed, Closed, Patient Pending, Secondary Pending, and Claims On Hold to update the payment status of each claim. To access these options, please select the submitted claim status and click the more icon, as shown in the image below.

• We also have the option to upload the billing reconciliation file. You can upload an Excel file with the claims data of each patient and check the history of the uploaded file. Additionally, you can download a sample file or sample reconciliation template by clicking on the "Download Reconciliation Template" button.

  

  

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Due Reminders:

PCM – Monthly Call Due:

If the difference between the last billable PCM clinical time date and the current date is greater than 30 days, clinical time can be added.

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