Principal Care Management

Table of Contents:

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

Eligibility Rules:

↑ Back to Top

• A minimum of one chronic condition should have existed for the previous 90 days.

CPT Rates:

↑ Back to Top

1. There are Two CPT codes for PCM.
2. Below are the details of these CPT codes with their rates.

Instructions:

1. Click on the PCM tab on the patient dashboard

As you can observe, an accordion is located at the top. It can be expanded and closed as required. By default, the patient details accordion will be closed.

And, once the expand button is 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, which is utilized to make a call to the patient on their cell phone.

1. Click on “Add PCM episode” to enter into “Consent” tab.
2. You will see a three sub tabs at the left side, which has the following sections:

• Consent
• Care Plan

• Activity

  with Clinical Timer on the top of the sub Tabs.

Consent:

↑ Back to Top

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

2. The Consent can be viewed in two Languages - English and Spanish.
3. By default, we have English language selected. Below is Consent screen in Spanish.
4. We can Upload attach a file which should be below 5mb in file size.

5. If the patient disagrees, then click on "Rejected by patient" and submit. This can be later edited.
6. 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.

8. At the bottom up can see the how review the consent and on which the consent was given and with the time.
9. When you click on next it will navigate you to the next sub tab which is Care plan tab.

Care Plan:

↑ Back to Top

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

1. After clicking on the Care Plan sub-tab, you will see the Health & Risk Assessment wizard.

1.1You will see a list of questions in which you have to choose one answer for each question. To answer more questions, scroll to the bottom.

1.2 After answering the question, click on the Save changes button.

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

2. After navigating to Problems List you will have Chronic Conditions, Allergies

2.1 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.

2.2 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.

2.3 To edit the data, hover on the input field to see Edit and Delete options. On clicking Edit button, respective pop-up appears, make changes you want to update and click on the Update Button. Once you have updated Diagnosis, click on Next Button, it redirects to Medications section.

3. You can see the list of Active Medications prescribed for the patient. You can add, edit, activate & inactivate, and delete medicines.

3.1 To add medicines, click on "Add Medicine" Button on the right. Add Medication Pop-up appears. To get prescription expiry reminder, check the box and select any of the two options - Remind before 5 days or 10 days and click on "Add Prescription" Button to save and add Prescription.

3.2 To edit any medicine, click on the respective Edit buttons. Upon clicking Edit button, Update Prescription pop-up appears, make the changes you want to update and click on Update Button.

3.3 To inactivate any medicine, switch the toggle to OFF state, the medicine will be inactivated. Switch the toggle to ON state, to activate the medicine back.

3.4 Click on Next Button, once you made your changes in Medications Section. Care Questionnaire section appears.

4. You will see the list of Questionnaire Question with Yes/No option or with an Text area for each question.

4.1 To answer more questions, scroll to the bottom. This is a mandatory section. You can add a care plan by answering all the questions in this section.

4.3 Click on Save & Continue Button, once you made your changes in Questionnaire Section. Findings & Goals section appears.

5. You will see the list of Findings Question with an Text area for each question and there will be short term and long term goals

5.1 To add a long term or short term goals click on the Add New button. Then Add Goals Pop-up appears. Which contains a text area. upon click on add. it will reflect in the desired section.

5.2 You can edit the goals by clicking the pencil icon on the goals card. Then, a Goals pop-up appears where you can edit your response and update it.

5.3 Click on Save & Continue Button, once you made your changes in Intervention & Monitoring Plan Section. Findings & Goals section appears.

6. You will see two sections as Life Style Modifications and Emergency Plan Question with an Text area for each question. To answer more questions, scroll to the bottom.

6.1 All the question in this section are mandatory and there are pre-filled and can make the changes as you need with out filling this complete section you can't be able to add a care plan.

6.1 Click on Save & Continue Button, once you made your changes in Findings & Goals Section. Other Details Section appears.

7. In this Section You will see questions with text area and which are not mandatory to fill.

7.1 The first section is a notes section in which you can added notes.

7.2 After making all the required changes click on the Add PCM Plan button. so that care plan get's added.

8. Now you can view two buttons: View Log History and View Summary below the wizard..

8.1 In the view log history, you can see every log. For example, when a program coordinator/provider makes any updates or edits, you can see the logs with names, dates, and times. By clicking on the button, you can view a pop-up where you can see the logs and download them in A4 format.

8.2 In the Summary view, you can see the total summary of the PCM service with 'From' and 'To' details, and it has an option to download the summary.

Activity:

You can Navigate to Activity sub tab to add an Activity.

You can add active by clicking on Add activity button on the Top Right. Add activity pop-up will 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 some descriptors from which you can select.

  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 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, cannot be edited/ deleted.

PCM History:

Once the care plan is submitted, you can see the PCM history on the top right in the RPM Label. Upon clicking on it, a small modal opens and you can discontinue the service.

• Upon clicking on the Discontinue Service Button, you will see a pop-up where you can provide 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, you have to provide new consent.

  

• Once the consent is submitted. then the old date will be auto-populated in all the 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.

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 click on Yes, the timer will start (billing time will begin) and you will navigate to that service in the patient dashboard. If you click No, you will navigate to that particular service in the dashboard without billing.

Billing Flow

• If you have clicked on the PCM service and then clicked on Yes to bill the time, it will navigate you to the service with the billing timer ON. This action will disable other services because when you are billing for a particular service, you can't navigate to other services such as PCM, TCM, RPM, or AWV.

  

• If you want to stop the billing, you can click on the STOP icon at the top near the header as follows.

  

• Once you STOP the billing, the other services will be enabled, and the bill will be reflected in the clinical time billing activity section.

From Service:

If you want to start the billing when you are in a particular service tab, then you can directly bill by clicking on the Start Billing icon at the top and follow the steps for Billing flow.

1. Now navigate to Clinical Time Tab. If you want to bill the records that are in the Billing section, then click the checkbox at the beginning of each record.

• You can see an "Add Bill" button on the Top Right of the table. Click on it to show a pop-up for adding a bill as follows.

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

  Note: If you select multiple records with different services, then it will be categorised as "others."

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

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

  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 billings.
• Patient - The patient's name will be pre-populated based on the record you selected in billings.
• From Date - It will be pre-populated, and the date and time will be based on the oldest record selected.
• To Date - It will be pre-populated, and the date and time will be based on the newest record selected.
• 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.

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

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

1. To access the Bills for PCM, please navigate to the Patient Dashboard and select the Billing Tab. The following screen will be displayed.
2. There are 4 sub-tabs - TCM, CCM, RPM, PCM, AWV and Others for billing logs related to each program.

1. Clicking on RPM, CCM, TCM and Others tab, will display calls list with checkboxes for each row with details as follows:

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

1. CPT codes are different for all types i.e., RPM, CCM, TCM and Others. CPT codes for all reimbursement types are different.
2. Billing Period- From and To date range can be selected in the Billing period to display the calls between the selected range.
3. Click on PCM tab.

1. User can use the Add Row option to add a row in the given list with entering the details like Billing Type, CPT code, topic, Provider, Patient, Date, Start Time, End time, Meeting Notes and call type.

1. To edit the call details click on the Edit icon in Action, allows user to edit the details like Billing type, CPT code, topic, Date, Provider, Meeting Notes, call type for selected row in the list. User can select the logs from the list and click on Submit.
2. The 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

Approve Time:

↑ Back to Top

1. The calls logs that are being submitted are saved in the Billing Portal. When the Admin logs in he can view the following screen.
2. By default, we have All Programs and All Providers selected. You can change it based on your preferences.

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

2. 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.

   

   

3. There are 5 filters - Status, Program, and Provider, Duration and Search Bills, using which we can search the bills to review.
4. User can filter the submitted billing list based on the Status of the bill in 4 categories.

• Submitted Bills
• Bills on Hold
• Accepted bills
• Rejected bills

1. Patients which are qualified by rules engine for the set of rules mentioned for respective CPT code, will be ready to Bill and patients which do not qualify the set of rules mentioned are rejected by rules engine.
2. User can filter the submitted billing list based on the type of billing or product (All/RPM/CCM/RTM/TCM/PMPM)
3. Click on the Status filter and select Submitted Bill option and Program filter and select CCM . The following screen can be seen.

1. 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 or Quarterly, by default, we have Monthly selected.

1. User can filter the submitted billing list based on the provider name for the specific center.
2. Search field will be available to search the required data on the dashboard.
3. Below the filters, we can see the table with following headers:

• Checkbox - To select all the records
• Patient EMR ID
• Patient Name
• Date of Service ( Date on which the service was provided)
• CPT Type (RPM/CCM/TCM/Others CPT code and Topic)
• Note (Meeting Notes while scheduling)
• Provider Name
• Bill details (Bill ID and Month Date, Year on which billing was submitted )
• Actions (Approve /On Hold /Reject)

1. All the submitted bills in the list, in the checkbox form, user can select the bulk actions to mark the selected bills as Approved or Rejected. And also can download the bills by clicking on the Download option.
2. Click on the checkbox and click on the Accept selected bills at the right, to submit the bills. You will view a pop-up to confirm if you want to accept the bill or not. Click on Yes to accept the bill.

3. We can also reject bulk bills by selecting the records and clicking on the "Reject selected claims" button, which will be visible in the headers once you select the bills. Upon clicking the button, a pop-up will appear where you have to enter the reason for rejecting the bills and click submit. The bills will then be seen under rejected bills.

   

4. You can perform actions - Approve, On Hold and Reject for individual calls. After the call log is being Approved/ is On Hold / Rejected. Those call logs will be categorised into Accepted/Rejected/On Hold respectively.

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

1. After the bills are accepted, we can view them by selecting the Status as Accepted.
2. Here, to download the Bill report, check the box for an individual record or check the box in the header to download report for all the reports.
3. We can download the report w.r.t any Status - All, Ready to bill, Submitted, On-Hold, Rejected and Approved.

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

2. 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.

   

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

   

   
   

4. 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.