Complex treatment changes
Assess PCM around the disease-specific plan and required management.
Contact us FOR YOUR PRACTICE
Oncology and serious-illness care
Distinguish managing a serious condition from helping a patient navigate the plan and barriers around it.
RELEVANT PATHWAYS
Does this patient need disease management, navigation, or both?
PCM addresses qualifying complex disease management. PIN supports navigation for a qualifying serious illness. Each requires its own service, appropriate personnel, and evidence; do not count the same work twice.
PCM · Principal Care Management
Disease-specific management for one complex, high-risk chronic condition.
Patient example, requirements, and billingPIN · Principal Illness Navigation
Condition-specific navigation with trained personnel and practitioner oversight.
Patient example, requirements, and billingCCM · Chronic Care Management
Broader coordination when multiple conditions and the CCM model independently fit.
Patient example, requirements, and billingCheck this before choosing a programA navigator is not a substitute for clinical management. Serious illness alone does not establish every program, and any overlapping services need independent eligibility and nonduplicated work.
EXAMPLES FOR YOUR SETTING
Start with a real need in your practice.
These scenarios show what to evaluate, rather than automatically assign a program or approve reimbursement.
Transport and caregiver barriers
Assess PIN to help the patient access planned treatment and return clinical questions to the team.
ONE ILLUSTRATIVE PIN JOURNEY
See the patient, practitioner, and support roles.
Meet Denise: cancer treatment involves several appointments, transport difficulties, and questions her caregiver cannot easily resolve.
Identify the need
Initiating visit- Patient / caregiver
- Discusses the illness, barriers, consent, and costs.
- Treating practice
- Performs the qualifying visit and establishes the condition-specific plan.
- PrimeVital’s agreed role
- Helps map navigation needs and the agreed support arrangement.
- What gets recorded
- Qualifying serious condition, visit, plan, and consent.
The sample goal
Help Denise complete the treating team’s plan and bring clinical questions back to that team.
YOUR INVOLVEMENT
Agree on responsibilities before the first patient starts.
Your organization
The treating practitioner owns the disease plan, clinical decisions, escalation, and final claims. Navigation personnel help with access and understanding.
PrimeVital’s agreed support
The agreed care-management team can support coordination and evidence handoffs. Navigation tasks and personnel training would be confirmed for the specific PIN engagement.
Service hours, professional qualifications, technology, integrations, records access, and fees are confirmed in the engagement. Front-desk automation handles agreed administrative tasks; clinical judgment and claims remain with the responsible qualified professionals.
WHAT YOU NEED TO DO
A practical launch checklist.
- Identify the condition, risk, initiating visit, consent, and responsible practitioner.
- Separate treatment management from navigation tasks.
- Confirm navigator training and clinical staff qualifications.
- Track eligible work and time without duplicating other programs.
- Check payer, hospice or other setting-specific arrangements before selecting a pathway.
PAYMENT & FINANCIAL PICTURE
Who gets paid, and what does the practice spend?
The eligible practitioner bills supported PCM or PIN services, subject to their distinct rules and payer terms. PrimeVital is paid through its agreement; navigation personnel do not independently bill Medicare PIN.
Illustrative PIN model
These starting figures are hypothetical. They are not Medicare rates, a PrimeVital quote, or a payment forecast. Replace them with your verified contract, service mix, and cost assumptions.
Service, device, and practice costs
Illustrative agreement: fees apply to enrolled patients, even if a service does not qualify for payment.
Leave at zero if already included in the service fee. Avoid counting it twice.
Shown separately from recurring operating costs.
35 of 50 patients meet the assumed service requirements.
Collections
$3,500
Operating costs
$2,150
Contribution
$1,350
$1,750 service fees + $0 additional device costs + $400 practice costs.
Contribution is before other overhead and taxes. Actual billing uses service-level evidence and rules; this simplified model does not select codes, approve eligibility, or guarantee outcomes. Patient cost sharing and QMB protections must be checked separately.
BENEFITS TO TRACK
Choose a baseline and a review date.
Agree on the measures that matter to your patients and team.
- Treatment appointments completed
- Barriers resolved
- Clinical questions handed back and closed
- Patient and caregiver understanding
Sources and scope
Reviewed October 7, 2026. Practice type alone does not establish clinical eligibility or payment. Detailed program pages maintain the code references; use the patient’s actual payer, professional, setting, and date of service.
YOUR PRACTICE, YOUR PATIENTS
Bring us the workflow you want to improve.
Share your practice type, patient group, payer mix, and current team. We can map the care pathway, available support, launch gaps, and assumptions to verify.
DESIGN A PRACTICAL STARTING POINT
Tell us where the workflow is breaking. We’ll show you where to begin.
Send us a message
Continue on your phoneScan to open a pre-addressed email draft.Email contact@theprimevital.com