Medicare offers multiple care management services to support patients with chronic conditions, with Advanced Primary Care Management Management (APCM) as one of the latest additions. While APCM and chronic care management (CCM) both enhance patient care and support continuity, APCM includes several key differences that may make it better suited for certain patient populations.
In this post, we’ll examine the differences between APCM and traditional CCM, highlighting coding, billing, and compliance requirements to help practices make informed decisions about implementing these services.
Traditional chronic care management (CCM) was introduced by Medicare to improve support for patients with multiple chronic conditions. CCM services provide ongoing, non-face-to-face care coordination and require a minimum of 20 minutes of clinical staff time per patient, per month. CCM can be delivered by physicians or non-physician practitioners (NPPs) with general supervision of clinical staff.
APCM expands care management service options for patients with chronic conditions. Patients eligible for APCM generally may require equivalent or less hands-on care management support than their counterparts enrolled in CCM programs. Medicare’s APCM service is designed to address the current gap in compensating primary care providers (PCPs) for the comprehensive and continuous care they offer to their patients — regardless of the exact time spent furnishing the services each month.
All Medicare beneficiaries are eligible for APCM. The beneficiaries who are likely to benefit most from APCM are those with one or more chronic conditions.
One of the most significant distinctions between APCM and CCM lies in the coding and reimbursement structure. Here’s a breakdown of the CPT codes commonly used for each service.
For CCM, Medicare offers several CPT codes depending on the complexity and time requirements of care management.
Unlike for CCM, APCM codes not time-based. APCM follows its own set of requirements and reimbursement models. APCM coding uses three HCPCS codes:
Since APCM often includes RPM as a complementary service, integrating these codes with the main APCM codes allows for a more flexible billing structure. This helps practices capture more revenue while meeting the complex care needs of APCM patients.
Both CCM and APCM are designed to support patients with chronic conditions, but there are key differences between the two services. CCM provides general support for patients with multiple chronic conditions, but APCM is more adaptable to a wider range of patient needs, including those with stable conditions and those requiring more complex management. Additionally, APCM offers more targeted billing codes, allowing providers to capture accurate reimbursement based on patient complexity.
Medicare’s documentation requirements for CCM are relatively straightforward, but APCM services require that 13 "service elements" must be "available" to patients each month to qualify for reimbursement. Each service element does not necessarily require practitioner action each month.
Comprehensive care plan: Each patient must have an up-to-date care plan, addressing their specific chronic conditions, medication management, and health goals.
Time tracking: Time spent remotely interacting with patients, and on care management activities, must be logged and tracked.
24/7 patient access: CMS requires that CCM patients have 24/7 access to their care team, either by telephone or electronic communication.
Patient Consent: Inform the patient about the service, obtain consent, and document it in the medical record.
Initiating visit: For new patients or those not seen within three years.
Continuity of care: Ensure continuity with a designated team member for successive routine appointments.
Alternative care delivery: Care delivery options alternative to office visits, such as home visits and/or expanded hours.
Overall comprehensive care management: Conduct systematic needs assessments, ensure receipt of preventive services, manage medications and general clinical oversight.
Patient-centered care plan: Develop and maintain a comprehensive electronic care plan accessible to the care team and patient.
24/7 access to care: Provide patients with 24/7 access to the care team/practitioner for urgent needs.
Coordination of care transitions: Coordinate transitions between healthcare settings and providers, ensuring timely exchange of health information and follow-up communication.
Ongoing communication: Coordinate with various service providers and document communications about the patient’s needs, goals, and preferences.
Enhanced communication opportunities: Enable communications through secure messaging, email, patient portals, and other digital means.
Population data analysis: Identify care gaps and offer additional interventions as appropriate.
Risk stratification: Use data to identify and target services to patients.
Performance measurement: Assess quality of care, total cost of care, and use of certified EHR technology.
The decision to offer APCM, CCM, or both should consider your patient population, staffing resources, and practice goals.
CCM may be better suited for non-primary care practices managing a patient population with a high prevalence of chronic conditions. These patients may require frequent remote interaction over the phone that can be tracked under CCM's time tracking requirements.
APCM is ideal for primary care practices managing patients with a spectrum of risk profiles. Some patients may need a relatively hands-off approach, while others may require more frequent touchpoints.
Navigating the complexities of APCM and CCM coding, compliance, and documentation can be challenging. Prevounce offers an integrated platform to support both APCM and CCM services, ensuring your practice can deliver compliant, high-quality care while optimizing revenue.
Automated time tracking and billing: Effortlessly capture all time spent on care management to ensure full reimbursement.
Care plan templates and compliance tools: Use comprehensive care plan templates for both APCM and CCM, ensuring Medicare compliance with every patient interaction.
APCM and CCM each bring unique benefits to Medicare providers, with APCM offering a more advanced care approach for patients with complex needs. By understanding the differences in coding, requirements, and compliance, providers can choose the right service to meet their patient population’s needs while enhancing practice revenue. For a streamlined, compliant approach to APCM and CCM, contact Prevounce today to see how our platform can support your care management goals.