Specialist - Provider Delivered Care Management

Blue Cross Blue Shield of Michigan expanded the Provider Delivered Care Management program to include select specialty physicians. Practitioners in the following specialty types* who have the required patient centered medical home neighborhood capabilities in place, completes the required training and meets care plan requirements may bill PDCM codes:

  • Oncology
  • Orthopedics
  • Cardiology
  • Pulmonology
  • Nephrology
  • Endocrinology
  • Palliative care
  • Orthopedics

Adding care management to your practice provides many benefits:

  • Creates an additional resource within your practice care team.
  • Care managers can bill for services, which provides additional revenue to your practice (varies with patient volume and insurance plan)
  • Provides revenue for many of the activities that a practice is already doing but not receiving reimbursement
  • Reduces workload of physicians (frees time spent with complex patients/family, coordination of care activities, etc.)

Each PDCM patient must have a care plan- either focused or comprehensive. The practice must be able to provide sample care plans upon request. Specialist practice care managers must share the care plan and coordinate care with the patients’ PCP.

 

Learn about Provider Delivered Care Management for specialty practices, benefits to your practice and more. View the presentation.

PDCM updates and eligibility information (2018)

Training information for PDCM-S can be located here.

*both adults and pediatrics qualify in these specialty types.

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