PCM vs. CCM: A Visual Overview

Principal Care Management (PCM) and Chronic Care Management (CCM) services are available to patients covered by Medicare Part B, aiming to improve the lives of those with chronic conditions. While they share numerous similarities, there are some important differences that healthcare providers need to know in order to maximize reimbursement opportunities. Today, we’ll use a handy little  chart to compare and contrast the two. 

A Visual Overview

The Primary Differences Between PCM and CCM

While PCM and CCM services are both intended for patients living with chronic conditions, each has a distinct focus. CCM patients must have a minimum of two chronic conditions that necessitate at least 12 months of treatment, whereas PCM patients have a single high-risk or complex chronic condition that typically requires at least three – but no more than 12 – months of treatment. 

Main Components of CCM Services:

1. Care planning and assessment 

2. Medication management 

3. Patient engagement and education 

4. Behavioral Health Integration (BHI) 

5. Social support services  

Main Components of PCM Services:

1. Continuous monitoring and adjustments to the care plan 

2. Specialist involvement and coordination 

3. Patient and caregiver communication 

4. Education on disease management 

5. Emergency planning  

Understanding the Difference is Key

PCM and CCM are both important assets in managing chronic conditions by providing personalized care, reducing hospitalizations, and cutting down on unnecessary duplicate services and human errors. Taking advantage of an AI-driven Chronic Care Management platform makes it easier for providers to determine patient eligibility, lower healthcare costs, and maximize opportunities for reimbursement. 

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