APCM is Medicare’s new initiative designed to support primary care providers in delivering continuous, proactive care to their patients. This program marks a major effort by the Centers for Medicare & Medicaid Services (CMS) to merge traditional fee-for-service (FFS) care with value-based, population-centered care models. APCM provides a valuable opportunity to explore population-based care management without the typical risks associated with value-based programs.
Advanced Primary Care Management
Introduction to APCM
Who Can Deliver APCM?
APCM services can be billed by providers “responsible for primary care and serve as the continuing focal point for healthcare services,” whether in a clinic, federally qualified health center (FQHC), or rural health center (RHC).
Billing Codes
CMS has introduced three HCPCS codes specifically for APCM, with each one representing a different level of patient medical and social complexity
G0556
For patients managing one or no chronic conditions.
G0557
For patients with two or more chronic conditions.
G0558
For patients who qualify as Medicare beneficiaries (QMB) and have two or more chronic conditions.
Each code mandates that the physician or qualified healthcare provider responsible for overseeing primary care and providing the general oversight of the Care Management Team and must offer and when necessary provide the following components:
1
Patient Consent
Clearly explain the service to the patient, obtain their consent, and document this in their medical records. WeCare completes all required facets of consent through a recorded process.
2
Introductory Visits
Schedule and conduct an initial consultation for new patients or those not seen within the last three years.
3
Continuity of Care
Assign a specific team members to ensure consistent care in future appointments.
4
Alternative Care Options
Provide alternatives to office visits, telehealth, such as home consultations or extended hours.
5
Comprehensive Care Management
Perform thorough evaluations, ensure preventive care services, manage medications, and oversee clinical care.
6
Personalized Care Plans with 24/7 Access
WeCAre creates and maintains a tailored electronic care plan accessible to the patient and care team, along with round-the-clock support for urgent needs.
7
Facilitating Care Transitions
Ensure smooth transitions between healthcare providers or settings through timely information sharing and follow-ups.
8
Collaborative Communication
Work with other service providers to document the patient’s needs, preferences, and goals accurately.
9
Secure Communication Channels
Offer communication through secure messaging, email, patient portals, and other digital platforms.
10
Data-Driven Population Analysis
Use data to identify care gaps and implement necessary interventions.
11
Risk-Based Care
Identify high-risk patients through data and provide tailored support and services.
12
Evaluating Performance
Monitor care quality, manage costs, and ensure compliance with certified EHR technology standards.
Best Practices for APCM Compliance
Utilize APCM-Compliant Software
APCM-compliant software streamlines documentation and billing by automating code generation and providing reminders for essential tasks, ensuring compliance and accuracy.
Ongoing Staff Training
Regular training sessions for the care team will keep them updated on APCM guidelines, CMS requirements, and best practices for proper documentation and care.
Monthly Compliance Audits
Conducting monthly reviews of documentation, billing, and care plans ensures adherence to CMS standards and helps mitigate potential compliance risks.
Monitor Patient Engagement and Satisfaction
Collecting patient feedback aids in refining service delivery, helping to meet CMS’s emphasis on patient engagement and high-quality care.
Thorough Documentation
Meticulous documentation of every patient interaction, care coordination effort, and care plan modification is essential to maintain continuity of care and comply with billing requirements.
Combining APCM with Remote Patient Monitoring
APCM and RPM are separate yet complementary services, each offering distinct benefits that improve patient care. APCM emphasizes ongoing care management with a collaborative care team, while RPM enables providers to remotely track vital health indicators, allowing for early intervention and the prevention of health issues. RPM serves as a valuable addition to APCM, offering continuous monitoring of patient health metrics. By integrating RPM with APCM, providers can enhance data-driven care and unlock new revenue opportunities.
Let’s Get Started
Hello, I’m Allan Brandvein, founder and CEO of WeCare Practice Partners. I invite you to examine the benefits of including a Comprehensive Care Management Program in your practice. Whether you have the physical space and the staffing to add a Care Management Department to your existing operation or you’d like to consider a turnkey managed solution, we’re here to help you set yourself up for success! Feel free to reach out to find out how we can help.
– Allan
