Principal Care Management (PCM) 2026: Guide to CPT Codes, Workflows & Medicare Updates

Principal Care Management (PCM) stands at the forefront of Medicare's 2026 strategy for value-based, patient-centered care delivery. 

Designed specifically for individuals managing a single complex chronic condition, PCM provides targeted care coordination that improves patient engagement, reduces preventable hospitalizations, and supports efficient care delivery through streamlined billing protocols and updated compliance policies.

What This Guide Covers

This comprehensive resource addresses:

• Principal Care Management 2026: Complete overview of essential updates and implementation strategies
• PCM CPT Codes: Detailed analysis of current, new, and revised codes with documentation and reimbursement implications
• Medicare Updates 2026: Key policy changes in the Medicare Physician Fee Schedule, including conversion factor adjustments and technology integration
• Operational Excellence: Detailed workflows, compliance requirements, billing best practices, and remote care solution integration

With healthcare's continued shift toward value-based models, understanding PCM's regulatory landscape, CPT coding requirements, billing optimization, and technology integration is essential for practice sustainability and superior patient outcomes.

Understanding Principal Care Management

What is Principal Care Management?

Principal Care Management (PCM) is a Medicare service providing comprehensive, disease-specific care management for patients with a single complex chronic condition that poses significant risk of hospitalization, functional decline, or death. 

PCM focuses on conditions expected to last three months or longer, requiring frequent treatment adjustments and ongoing care coordination.

CMS Definition and Scope

According to CMS, PCM encompasses disease-specific management and coordination for beneficiaries who:

• Have one high-risk chronic condition
• Face significant risk of acute exacerbation, hospitalization, functional or cognitive decline, or death
• Require frequent adjustments to care plans and treatment regimens

Distinguishing PCM from Related Services

Key Distinctions:

• PCM: Focused management of a single, complex chronic condition
• CCM: Addresses patients with multiple chronic conditions and ongoing, multifaceted needs
• TCM: Covers patients transitioning to community care after hospitalization within the first 30 days post-discharge

Patient Eligibility Criteria

Qualifying patients must meet the following requirements:

• Diagnosis of one complex chronic condition expected to last three months or longer
• Clinical situation placing patient at significant risk for hospitalization, acute exacerbation, functional decline, or death
• Requirement for frequent medication and treatment changes, or unusually complex management due to comorbidities
• Physician or qualified health professional must create and regularly update a care plan

Commonly Managed Conditions

PCM is frequently utilized for:

• Congestive Heart Failure (CHF)
• Chronic Obstructive Pulmonary Disease (COPD)
• Uncontrolled Diabetes
• Late-stage Kidney Disease
• Advanced Cancer

PCM's targeted approach ensures patients with serious chronic challenges receive proactive, specialized management to stabilize and improve their condition.

PCM's Role in U.S. Healthcare

Addressing the Chronic Disease Crisis

Principal Care Management responds to a critical healthcare challenge. According to the CDC, approximately 194 million U.S. adults—over 76%—had at least one chronic condition in 2023. 

Moreover, 90% of the nation's $4.9 trillion annual healthcare expenditure goes to people with chronic and mental health conditions. Medicare spending on chronic disease management remains a major driver of federal healthcare costs.

Filling Critical Care Gaps

PCM was introduced to address gaps for patients with a single, high-risk chronic illness placing them at elevated risk for hospitalization, functional decline, or death. Rather than spreading resources thinly over multiple conditions, PCM offers disease-specific management, coordinated interventions, and regular monitoring for those with the most acute needs. This targeted, continuous approach proves especially valuable for conditions like CHF, COPD, diabetes, and end-stage kidney disease.

Benefits for Patients

• Reduced Readmissions: PCM reduces preventable hospitalizations through early intervention, improved care follow-up, and rapid adjustments to care plans.
• Better Medication Adherence: Patients receive ongoing support and education, helping them understand, manage, and adhere to complex medication regimens.
• Improved Engagement: PCM enhances patient engagement through regular check-ins, personalized support, and an ongoing relationship with a dedicated care team, leading to higher satisfaction.

Benefits for Providers

• Optimized Reimbursements: PCM is structured around updated CPT codes and CMS policies offering direct reimbursements for chronic care coordination, creating stable revenue without overburdening staff resources.
• Structured Workflow: Disease-specific workflows enable better case management, standardized care processes, and more efficient use of staff time.
• Audit Readiness: Comprehensive documentation, regular patient touchpoints, and robust care planning help providers ensure regulatory compliance and readiness for reimbursement audits.

The expansion of PCM aligns Medicare incentives, clinical workflows, and patient needs—supporting better outcomes for chronic disease patients and stronger sustainability for healthcare organizations.

Essential Components of Successful PCM Programs

1. Comprehensive Care Plan

A thorough assessment culminates in a detailed, personalized care plan tailored to the patient's specific condition and risk factors.

Key Elements:

• Distinct treatment goals
• Listed interventions
• Clear allocation of responsibilities among care team members
• Proactive sharing with patient, relevant caregivers, and all care team members to maintain transparency and facilitate regular updates

2. Ongoing Care Coordination

Effective PCM requires regular, structured communication and collaboration among:

• Primary care providers
• Specialists
• Laboratories
• Imaging centers
• Other involved parties

Coordination protocols help close care gaps and avoid duplicate or conflicting interventions as medications and therapies are modified.

3. Medication Management

Routine Review: All active prescriptions are reviewed to ensure safe combinations and identify potential drug interactions or harmful side effects.

Timely Adjustments: Medication regimens are modified promptly in response to changing symptoms or lab results.

4. Patient & Caregiver Communication

Successful PCM hinges on:

• Regular patient education empowering individuals and caregivers with knowledge about their condition
• Self-management techniques
• Importance of adherence
• Ongoing communication through scheduled follow-ups and digital engagement

This approach improves self-care and builds trust with the health team.

5. Documentation & Billing Compliance

Critical Requirements:

• All patient interactions, interventions, and time spent on care activities must be recorded accurately within Electronic Health Records (EHRs) for Medicare billing and audit purposes
• Consent for care management is obtained and documented
• Clear logs of monthly activities and plan updates support compliance and reimbursement

This structured approach maximizes clinical outcomes, stabilizes costs, and positions providers for optimal reimbursement under evolving Medicare rules.

Provider Eligibility and Qualifications

Who Can Provide PCM Services?

PCM services may be provided and billed by a range of qualified healthcare professionals according to CMS guidelines:

Primary Eligible Providers:

• Physicians: Both MDs and DOs are eligible to provide and bill for PCM services
• Nurse Practitioners (NP): NPs with appropriate licensure can oversee PCM care plans and bill Medicare directly
• Physician Assistants (PA): PAs may manage PCM for qualifying patients and submit claims under their NPI
• Clinical Nurse Specialists (CNS): CNSs are authorized to provide and bill PCM within their scope of clinical practice

Additional Qualified Providers:

• Certified Nurse Midwives
• Pharmacists (in some settings and appropriate billing arrangements)

Key Requirements

• PCM services must be billed by a practitioner with an NPI
• Clinical staff (such as RNs or care coordinators) may deliver most care components under the direction and supervision of the billing provider
• Only one provider may bill for PCM services per patient, per month
• Eligibility centers on CMS's definition of a qualified healthcare professional, appropriate licensure, and adherence to "incident to" Medicare rules for roles and supervision

PCM CPT Codes & Reimbursement for 2026

Primary CPT Codes

For 2026, Medicare continues to use four primary PCM CPT codes for billing and reimbursement:

Usage Guidelines:

• 99424/99425: Billed for time spent directly by physicians or qualified health professionals (QHPs)
• 99426/99427: Cover time spent by clinical staff under direct supervision of a physician or QHP

National Average Reimbursements

2026 Rates:

• National average reimbursement ranges approximately $50–$82 per patient per month, depending on the code used and time documented
• The 2026 Physician Fee Schedule rules anticipate an 8–10% reimbursement increase for chronic care management, impacting PCM rates

Regional Variations:

• Regional reimbursement differences occur due to Medicare's Geographic Practice Cost Index (GPCI)
• Higher cost-of-living areas generally see moderately increased payments

Time-Based Billing Requirements

Documentation Standards:

• PCM codes require time-based documentation: 99424/99426 (≥30 min), 99425/99427 (each addl. 30 min) within the calendar month
• Only one provider (or group practice) may bill PCM per patient per month
• PCM cannot be billed concurrently with CCM for the same condition to avoid double billing
• Clinical staff time must be supervised and logged accurately, showing activities performed for the eligible chronic condition

Telehealth Flexibility

2026 CMS Policies:

• Medicare rules continue to allow PCM codes to be billed for telehealth encounters
• All requirements for assessment, care plan management, and documentation must be met
• CMS may offer temporary waivers allowing greater flexibility in telehealth or remote patient monitoring (RPM) integration, especially in rural or underserved areas
• Close adherence to evolving regulatory guidance is required

A well-structured PCM program documenting direct patient engagement, time commitments, and services delivered—whether in-person or via telehealth—positions providers to maximize reimbursement while staying compliant in 2026.

Eligibility & Documentation Requirements

Patient Eligibility Standards

To bill for PCM services, patients must meet specific criteria:

Core Requirements:

• One complex chronic condition expected to last at least three months
• Condition associated with increased risk of hospitalization, functional decline, or death
• Enrolled in Medicare Part B coverage
• Written or verbal consent obtained and documented

Consent Requirements: The provider must obtain and document consent, educating the patient about:

• PCM services and what they entail
• Possible cost sharing
• Rights to discontinue services at any time

Avoiding Service Overlap

Critical Billing Rules:

• Only one provider can bill PCM, CCM, or TCM for a patient per month
• Exception: Separate providers managing different conditions with distinct care plans (detailed logs and justification required)
• PCM cannot be billed for overlapping time or the same activities as CCM, TCM, or RPM
• Clinical responsibility and billing authority must be clearly noted at enrollment and in monthly care records

Detailed Documentation Requirements

1. Condition-Specific Notes:

• Record diagnosis
• Disease acuity
• Recent exacerbation/hospitalization
• Rationale for PCM eligibility

2. Time Tracking:

• Document at least 30 minutes per month spent on PCM activities
• Log additional time for higher-level billing
• Include date, tasks performed, and provider/clinical staff identity

3. Care Plan Updates:

• Maintain disease-specific plans
• Periodically review and update based on clinical progress and interventions

4. Consent Forms:

• Keep documentation (electronic or paper) of written or verbal patient consent in the medical record
• Note the date consent was provided

Providers must ensure records are precise and audit-ready, including rationale for care management selection, time logs, care plan sharing, and patient communication to avoid denied claims or compliance risk.

Common Billing Pitfalls & Solutions

Pitfall 1: Inaccurate Time Tracking

• Problem: Billing without accurately logged time spent on PCM activities or aggregating unrelated tasks.
• Solution: Maintain detailed logs of time spent each month on eligible PCM services, separately tracking time for initial (99424/99426) and additional units (99425/99427) with exact dates and activities.

Pitfall 2: Incomplete Care Plans

• Problem: Insufficient detail or lack of updates in condition-specific care plans.
• Solution: Develop comprehensive care plans with clear goals, interventions, and responsibilities. Update regularly to reflect clinical changes. Share with patients and care teams to support continuity and audits.

Pitfall 3: Missing Patient Consent

• Problem: Failing to document patient consent causes claim denials.
• Solution: Secure written or verbal consent before billing. Document date, type of consent, and patient understanding of costs and the option to discontinue services.

Pitfall 4: Duplicate Billing with CCM or TCM

• Problem: Billing PCM concurrently with Chronic Care Management (CCM) or Transitional Care Management (TCM) codes for the same condition or timeframe.
• Solution: Confirm distinct conditions for PCM vs. CCM. Do not bill PCM alongside CCM/TCM for overlapping time. Coordinate with other providers to delineate responsibility.

Pitfall 5: Incorrect Place of Service or Modifier Usage

• Problem: Improper use of place of service codes or missing CMS-required modifiers, especially for telehealth services.
• Solution: Follow CMS guidance on appropriate place of service designations. Use modifiers (e.g., 95 or GT for telehealth) where applicable to ensure proper reimbursement.

Audit Preparation Tips

Risk Mitigation Strategies:

• Keep thorough, audit-ready documentation with time logs, consent forms, care plans, and communication records
• Regularly review billing practices against the latest CMS guidance and payer-specific policies
• Train billing and clinical staff on PCM program requirements to minimize errors and duplicate claims

Proactively addressing these common pitfalls protects revenue streams while supporting quality chronic care management under Medicare's evolving PCM guidelines.

Maximizing PCM Reimbursements

Strategy 1: Early Patient Identification

Implementation:

• Prioritize enrollment of patients with recent hospital discharges
• Focus on unstable or frequently exacerbating chronic conditions such as CHF or COPD
• Use data analytics and EHR alerts to flag candidates who meet PCM eligibility for timely care plan initiation and billing

Strategy 2: Bundling PCM with RPM Services

Approach:

• Combine PCM with Remote Patient Monitoring where appropriate
• Integration supports better clinical oversight and can increase total reimbursable care time
• Ensure distinct documentation for each program to comply with Medicare billing rules and avoid overlap

Strategy 3: Structured Workflows

Key Elements:

• Establish standardized workflows that clearly delineate PCM activities, documentation, patient communication, and billing procedures
• Use templates within EHR systems for comprehensive care plans, consent, and time tracking
• Facilitate compliance and reduce administrative errors

Strategy 4: Quarterly Internal Audits

Process:

• Regularly audit PCM claims to verify accuracy of time logs, care plan completeness, and patient consent documentation
• Address any documentation gaps, incorrect billing, or duplication issues promptly
• Minimize claim denials and compliance risks

Strategy 5: Staff Training and Technology Utilization

Investment Areas:

• Ongoing staff education on PCM clinical and billing guidelines, including updates from CMS for 2026
• Deploy technology solutions such as:
  • Automated time-tracking
  • Care coordination platforms
  • Telehealth integration
• Streamline PCM delivery and billing operations

Employing these strategies enhances care quality and strengthens reimbursement capture, ensuring sustained program success and regulatory compliance under 2026 Medicare PCM policies.

PCM Program Workflow & Best Practices

Step 1: Identify Patients & Verify Eligibility

Process:

• Use Electronic Health Record (EHR) queries, referrals, and ICD-10 diagnosis coding
• Pinpoint Medicare Part B beneficiaries with a single complex chronic condition eligible for PCM
• Validate condition duration (≥3 months) and risk factors such as recent hospitalizations or functional decline

Step 2: Patient Consent & Education

Requirements:

• Obtain and document patient consent verbally or in writing
• Explain PCM services, potential costs, and right to stop anytime
• Educate patients on their condition, care goals, and what to expect from ongoing management

Step 3: Comprehensive Assessment & Care Plan Development

Activities:

• Conduct thorough review of:
  • Laboratory results
  • Medication adherence
  • Social determinants of health (SDOH)
  • Other relevant factors
• Develop a personalized and measurable care plan outlining:
  • Treatment goals
  • Interventions
  • Responsible care team members

Step 4: Monthly PCM Service Delivery

Core Services:

• Provide ongoing non-face-to-face management activities:
  • Symptom monitoring
  • Medication adjustments
  • Coordination with specialists
• Facilitate multidisciplinary collaboration across care teams to address patient needs holistically

Step 5: Documentation for Compliance

Essential Records:

• Document all care activities, time spent, patient interactions, care plan updates, and consent in the EHR
• Ensure documentation meets CMS time-based billing and clinical validation requirements

Step 6: Medicare PCM Billing Process

Billing Execution:

• Submit claims with appropriate CPT codes:
  • 99424/99425 for physicians/QHPs
  • 99426/99427 for clinical staff
• Reflect documented time accurately
• Avoid duplicate billing with CCM, TCM, or RPM codes by maintaining clear clinical and billing boundaries

Step 7: Quality Assurance & Audit Readiness

Ongoing Monitoring:

• Conduct regular internal audits to verify:
  • Documentation accuracy
  • Time logs
  • Patient consent
  • Compliance with Medicare policies
• Train clinical and billing staff continuously to adapt to evolving CMS requirements
• Reduce risk of claim denials

This evidence-based PCM workflow balances comprehensive chronic disease management with regulatory compliance, optimizing patient outcomes and sustainable reimbursement.

Compliance & Audit Readiness

The Four Pillars of PCM Compliance

Pillar 1: Patient Consent Documentation

Requirements:

• Secure and document informed patient consent before initiating PCM services
• Consent must explain:
  • Service scope
  • Potential cost-sharing
  • Patient rights
• Keep records for audit verification

Pillar 2: Timely, Accurate Care Plan Updates

Standards:

• Maintain comprehensive, up-to-date condition-specific care plans
• Reflect clinical status, goals, and interventions
• Documentation should show periodic review and modification as required by patient's evolving condition

Pillar 3: Time Tracking Integrity

Best Practices:

• Accurately log all time spent on PCM activities per patient monthly
• Separate initial and additional units according to CPT requirements
• Ensure clear distinctions between time for PCM and other chronic care codes like CCM or RPM to prevent overlap

Pillar 4: Billing & Claim Documentation

Critical Elements:

• Submit claims consistent with documented services and time tracked
• Use correct CPT codes (99424-99427), modifiers, and place of service indicators
• Retain complete documentation to support claims for CMS audits or payer reviews

Regulatory Updates & Ongoing Monitoring

Staying Current:

• Stay informed on CMS policy changes related to:
  • PCM
  • Telehealth expansions
  • Coding updates
• Monitor official CMS communications
• Conduct regular internal audits
• Implement staff training programs
• Make continuous process improvements to adapt to evolving compliance standards

Adhering to these audit readiness pillars reinforces the integrity of PCM programs, enhances the likelihood of successful reimbursement, and safeguards against regulatory penalties while reinforcing patient-centered care.

Technology & Tools for PCM Success

Foundation: EHRs and PCM-Specific Platforms

Electronic Health Records (EHRs):

• Serve as the foundation for identifying eligible patients
• Enable documentation of care plans
• Support time tracking
• Record consents in integrated workflows

Dedicated PCM Platforms:

• Complement EHRs by automating PCM-specific tasks
• Streamline clinical and administrative processes
• Improve outcomes and billing accuracy

Key Features of Dedicated PCM Platforms

1. Automated Time Tracking:

• Simplifies documentation of care management minutes spent per patient
• Supports accurate billing for 99424-99427 codes

2. Dynamic Care Plan Management:

• Enables easy creation, updates, and sharing of comprehensive, condition-specific care plans
• Accessible to care team and patients

3. Secure Communication & Consent Capture:

• Facilitates HIPAA-compliant messaging with patients and caregivers
• Obtains and stores informed consents electronically

4. Billing Integration and Reporting:

• Supports claim submissions
• Tracks reimbursement
• Generates audit-ready reports on PCM activities and compliance metrics

5. Workflow Optimization:

• Automates reminders
• Manages care coordination tasks
• Schedules follow-ups to maintain continuity of care and provider efficiency

Integration with Remote Patient Monitoring (RPM)

Clinical Benefits:

• Clinical data collected through RPM devices integrates with PCM platforms
• Enables real-time monitoring of patient status
• Supports early interventions to avoid hospitalizations

Financial Benefits:

• RPM billing opportunities include:
  • CPT 99453 (device setup)
  • CPT 99454 (device monitoring)
  • CPT 99457 (interactive communication)
• Augments PCM reimbursements when deployed in tandem

Operational Advantages:

• Integrated platforms facilitate seamless documentation
• Coordinate between PCM and RPM programs
• Enhance both clinical outcomes and revenue capture

Incorporating advanced technology solutions tailored to PCM helps providers deliver high-quality, comprehensive chronic care while ensuring adherence to Medicare requirements and maximizing financial performance.

Future Outlook—PCM & Medicare 2026

Telehealth Flexibility

Expanded Access:

• Medicare continues to expand telehealth allowances for PCM
• Enables providers to deliver and bill remote care management activities with fewer geographic and modality restrictions in 2026
• Supports patient access and convenience, especially for those with mobility challenges or living in rural areas

Payment Increases: 2026 Medicare Physician Fee Schedule

Financial Impact:

• The 2026 Medicare Physician Fee Schedule final rule includes upward adjustments to PCM reimbursement rates
• Reflects CMS's emphasis on chronic disease management and care coordination
• Providers can expect approximately 8-10% increase in fees
• Enhances PCM's financial sustainability

CMS Trends: APCM and Behavioral Health Integration

Advanced Primary Care Management (APCM):

• Gaining traction as part of Medicare's value-based care strategy
• Offers broader scope care versus PCM's focus on single chronic conditions

Behavioral Health Integration (BHI):

• Increasingly incorporated into PCM to address mental health comorbidities
• Common in chronic disease populations

RPM & RTM Expansion

Remote Monitoring Growth:

• Remote Patient Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) are expanding under Medicare
• Increased billing opportunities
• Tighter integration into PCM workflows
• Supports continuous patient data collection and proactive management

Clinical Benefits:

• This synergy supports:
  • Earlier interventions
  • Better adherence
  • Holistic care coverage

Emerging Technology & AI Integration

Artificial Intelligence Applications

AI tools are increasingly being integrated into PCM platforms, enhancing clinical decision-making and improving patient outcomes through three key capabilities:

1. Predictive Analytics
AI models analyse historical vitals, symptoms, and behavioural trends to predict upcoming risks—such as a potential COPD flare-up or blood pressure spike.
 Example: The platform alerts the care team when a patient’s vitals show early signs of decompensation, enabling proactive outreach before hospitalization becomes likely.

2. Risk Stratification
AI automatically categorises patients into low-, medium-, or high-risk tiers based on their conditions, medication adherence, and engagement levels.
 Example: High-risk patients with frequent abnormal readings are flagged for more frequent nurse check-ins, while stable patients receive lighter-touch monitoring.

3. Personalized Care Plan Optimization
AI recommends tailored adjustments to care plans by evaluating patient-specific data such as lifestyle patterns, vitals, and reported symptoms.
 Example: If a diabetic patient consistently shows elevated glucose after dinner, the system may suggest a nutrition review or a medication timing adjustment.

Administrative Efficiency

AI-driven platforms significantly streamline administrative workflows by automating documentation, coding, and billing, which reduces provider burden and improves overall accuracy.
Solutions like Circle Health, CareSimple, and HealthArc enhance administrative efficiency by integrating RPM, CCM, RTM, and PCM into a unified system—minimising manual tasks, improving data consistency, and ensuring cleaner claims submission.

These platforms help practices:

• Automate documentation and clinical note generation
  
   
• Support accurate coding for RPM/CCM/RTM/PCM
  
   
• Streamline billing workflows to reduce denials
  
   
• Lower administrative workload for care teams

These trends usher in a more flexible, technologically empowered PCM environment in 2026, reinforcing Medicare's commitment to value-based, patient-centered chronic care.

Conclusion

Principal Care Management (PCM) represents a transformative, patient-centered care model designed specifically for individuals with one complex chronic condition. By focusing on coordinated, comprehensive care, PCM aims to stabilize patient health and reduce the risk of complications. 

The program's benefits are substantial: lower hospitalizations, improved patient outcomes, and enhanced reimbursements for providers through Medicare's evolving policies.

Success in PCM requires leveraging technology and structured workflows to create scalable, efficient programs that meet both clinical excellence and compliance standards. As Medicare continues to refine value-based care models, PCM stands as a cornerstone of effective chronic disease management.

Frequently Asked Questions

Q: What is Principal Care Management (PCM)?

A: PCM is a Medicare-covered service focused on managing patients with a single, complex chronic condition through dedicated care coordination, personalized care plans, and ongoing monitoring.

Q: Who is eligible for PCM in 2026?

A: Patients with one high-risk, complex chronic condition expected to last at least three months, covered by Medicare Part B, and at significant risk of hospitalization or decline.

Q: How does PCM differ from CCM?

A: PCM targets one complex chronic condition, whereas CCM manages multiple chronic conditions simultaneously. PCM involves condition-specific care plans and services.

Q: What are the CPT codes for PCM in 2026?

A: The four primary codes are:

• 99424: First 30 minutes (physician/QHP)
• 99425: Additional 30 minutes (physician/QHP)
• 99426: First 30 minutes (clinical staff)
• 99427: Additional 30 minutes (clinical staff)

Q: What documentation is necessary for PCM billing?

A: Required documentation includes:

• Patient eligibility verification
• Informed consent
• Condition-specific care plans with regular updates
• Detailed time tracking of PCM activities
• Billing records

Q: Can PCM be combined with RPM?

A: Yes, PCM can be bundled with Remote Patient Monitoring (RPM) to enhance outcomes and increase reimbursement, provided documentation clearly delineates services and billing codes follow Medicare rules.

Q: How do providers maximize PCM reimbursement?

A: Through:

• Early identification of high-need patients
• Structured workflows
• Comprehensive documentation
• Technology utilization
• Conducting internal audits for compliance

Q: How do PCM audits work?

A: Audits review patient consent, care plans, time tracking, and billing claims for compliance with CMS policies. Maintaining thorough, accurate records and regular staff training are key to audit readiness.