Care Management for Orthopedic, Pain, and Joint Practices

Reviewed by Jack Wright, Managing Partner

Orthopedic, pain, and joint practices carry a patient panel that fits Medicare care management well, yet most either skip it or hand it to an outside vendor. If your patients live with osteoarthritis, chronic low back pain, or one or more chronic conditions alongside their joint disease, Medicare pays your practice for the between-visit coordination your team already provides. This page is for the owner or administrator weighing whether to build that program in-house, and which programs actually fit a musculoskeletal panel.

Which programs fit a musculoskeletal panel

Two Medicare programs do most of the work for an MSK practice, and a third covers part of your panel.

• Principal Care Management (PCM) pays for monthly management of one high-risk chronic condition. Many MSK patients qualify on a single joint or spine condition, which makes PCM the natural place for a specialty practice to start.
• Remote Therapeutic Monitoring (RTM) follows therapy adherence and response at home, including pain scores, function, and home-exercise progress. That lines up with how you already track a joint or spine patient between visits.
• Chronic Care Management (CCM) fits the older osteoarthritis patient who carries two or more chronic conditions and needs whole-patient coordination. For a given patient in a given month, one practitioner bills CCM or PCM, not both, so choosing the right program matters.

Why practices build it in-house instead of using a revenue-share vendor

Most care management vendors charge on revenue share: they keep a percentage of every Medicare payment for as long as the patient stays enrolled. That model costs more than the percentage suggests.

• The claim goes out under your NPI. The revenue, the records, and the audit exposure are yours no matter who does the work, so a revenue-share vendor takes a cut of something your practice is already accountable for.
• Your own staff hold the patient relationship and the data. An in-house coordinator who knows the patient and works inside your systems sits closer to the clinical picture than an outside call center.
• A proposed CY2027 Medicare rule would let RPM and RTM be billed only when the clinical staff furnishing them are the billing practice’s own employees. It covers RPM and RTM only, and it remains a proposal, not a final rule. A program your own employees already run is built that way from the start, and there is a transition checklist if you run those two programs through a vendor today.

Building in-house is not effortless. It takes the right program selection, the right staffing and supervision, documented workflows, and billing discipline. That build is the work PMC does through its care management implementation service.

What PMC does in setup

Practice Management Consultancy designs and builds the program. Your own employees run it day to day, and your practice or your biller submits the claims. A typical setup covers:

• Program selection: which of PCM, RTM, and CCM fit your panel, and how to combine them without counting the same staff minute twice.
• A staffing model built around your own employees: who does the monthly work, under whose supervision, and how their time is captured and logged. A care coordinator job description that matches the billing rules is part of this.
• Workflows and SOPs: enrollment, consent, the monthly touchpoints, documentation, and a time log that holds up in an audit.
• Vendor-neutral platform selection: we help you pick the monitoring and documentation tools that suit your practice, and we do not sell one.
• Billing-mechanics consulting: the codes, modifiers, date-of-service rules, and the denials to expect, so the claims your team submits are right the first time.

We designed and built this kind of program at a non-surgical joint clinic our founder operates. The six-month write-up walks through what we built and who runs it.

What this is not

PMC implements and advises. We do not run your care management program, we do not employ your coordinators, and we do not operate your billing. Your staff runs the program, and your team or your biller submits the claims. We build it so they can.

Common questions

Can a smaller specialty practice run this without hiring a full team?

Often, yes. Part of program selection is sizing the monthly work against the staff you already have, and deciding whether an existing clinical employee can take it on under the right supervision before anyone hires. We design the staffing model around your practice, not a fixed headcount.

We use a vendor now. Does the 2027 proposal force a change?

Not today, and not for every program. The proposed employee-staffing requirement covers RPM and RTM only, and it is still a proposal awaiting a final rule. It does not touch outsourced CCM or PCM. Moving a program in-house now is about controlling the timeline on your terms instead of scrambling if the rule is finalized as written.

If you are weighing an in-house program against a vendor, book a call and we will map which programs fit your panel and what the build will take.