Advanced Primary Care Management Management (APCM) is a new Medicare service, finalized in the 2025 Medicare Physician Fee Schedule final rule, that allows healthcare providers to deliver enhanced, continuous care to patients. Implementing APCM can elevate the quality of patient care and provide a new revenue stream for practices.
However, setting up APCM involves strategic planning, compliance, and technology considerations. In this post, we’ll outline the steps you should take to effectively launch APCM in your practice, helping ensure that your setup is seamless, compliant, and poised for long-term success.
1. Assess Your Patient Population for APCM
The first step in implementing APCM is identifying which patients could benefit most from these services. APCM is designed for all Medicare patients, including those with chronic conditions (i.e. diabetes, hypertension, and COPD) and those with no chronic conditions.
How to assess your patient population:
- Review patient health records: Use your technology to identify patients eligible for APCM.
- Define eligibility criteria: You may focus on patients with comorbidities or recent hospitalizations who are likely to benefit from proactive care.
- Leverage technology for patient selection: Software platforms, like Prevounce, can help streamline patient identification by automating the process based on Medicare APCM criteria.
2. Develop a Comprehensive Care Management Protocol
Once you have identified eligible patients, the next step is to establish care protocols that your care team will use to deliver ongoing APCM services. A well-defined care management protocol helps standardize APCM delivery and ensures compliance with Medicare’s requirements.
Key components of an APCM protocol:
- Patient assessment and goals: Create individualized care plans with specific health goals.
- Communication plan: Establish a regular schedule for patient touchpoints, including telehealth visits, phone check-ins, and any necessary in-person visits.
- Emergency and escalation procedures: Define protocols for managing urgent situations or significant changes in a patient’s condition.
- Monitoring and adjustments: Outline procedures for adjusting care plans based on patient progress and ongoing assessments.
3. Assemble Your APCM Care Team
APCM services thrive on a team-based approach, leveraging a variety of healthcare professionals to deliver comprehensive care. Your care team should be carefully chosen based on their expertise, availability, and roles in care management.
Typical roles on an APCM care team:
- Primary care physicians or nurse practitioners: Lead care decisions and oversee patient management.
- Registered nurses and care managers: Handle routine patient check-ins, follow-up care, and care coordination.
- Social workers or behavioral health specialists: Address social determinants of health (SDOH)/health-related social needs (HRSN), mental health needs, and any patient barriers to care.
- Administrative staff: Support billing, scheduling, and documentation for compliance and reimbursement.
Ensure your team is trained on APCM requirements, patient engagement best practices, and HIPAA compliance to protect patient privacy.
4. Implement APCM-Compatible Technology
Effective APCM requires technology to facilitate documentation, communication, and compliance. From EHR integration to patient monitoring devices, using the right tools will streamline APCM processes and support your team in delivering top-notch care.
Technology essentials for APCM:
- APCM management platform: Consider using a specialized platform like Prevounce, which automates billing, helps you capture APCM activities, and simplifies compliance with CMS guidelines.
- Remote patient monitoring (RPM): If relevant, integrate RPM devices to continuously monitor key health metrics such as blood pressure or blood glucose.
- Patient communication tools: Secure patient communication systems (e.g., patient portals or telehealth platforms) enable your team to maintain consistent contact with patients.
5. Create a Documentation and Billing Workflow
A successful APCM setup includes a clear workflow for documentation and billing. Medicare’s APCM services have specific documentation and billing requirements, so your team must track all relevant activities and ensure that billing codes are applied accurately.
Steps for setting up documentation and billing:
- Documentation standards: Set guidelines for capturing patient interactions, changes in care plans, and any other billable APCM services.
- Billing code management: Familiarize your billing team with APCM-specific codes (HCPCS G0556, G0557, G0558) to better ensure accurate reimbursement.
- Monthly reports for billing compliance: Prepare monthly reports to review APCM services provided, ensuring that all activities meet CMS’s billing standards.
By investing time in establishing a billing workflow, your practice can optimize revenue from APCM services and ensure compliance with Medicare requirements.
6. Engage and Educate Patients on APCM
Once APCM is set up, educating eligible patients on its benefits and what they can expect is essential. When patients understand the value of APCM, they are more likely to engage with care plans, adhere to medical advice, and experience improved outcomes.
Tips for patient engagement:
- Explain APCM benefits: Emphasize how APCM’s continuous, proactive care model can prevent health complications and improve quality of life.
- Set clear expectations: Outline how frequently your team will be in touch, what services they’ll receive, and any responsibilities they may have.
- Use simple, accessible communication: Ensure that communication is clear and adapted to meet the needs and preferences of each patient.
- Encourage feedback: Provide ways for patients to give feedback about their experience with APCM, which can help improve service delivery and patient satisfaction.
7. Monitor and Adjust Your APCM Program
Once your APCM program is running, monitoring performance is key to ongoing success. Regularly review patient outcomes, team workflows, and financial metrics to identify areas for improvement.
How to monitor and improve APCM services:
- Track patient health outcomes: Use data to monitor health improvements, reduced hospitalizations, and treatment adherence.
- Review financial performance: Assess billing efficiency, reimbursement rates, and revenue generated from APCM to ensure financial goals are met.
- Implement continuous training: As Medicare updates its APCM policies, keep your team informed through regular training and updates.
Partnering with Prevounce for APCM Success
Prevounce offers comprehensive support to help practices establish and optimize APCM services. With a range of tools tailored to APCM, Prevounce simplifies patient enrollment, billing, and compliance, so providers can focus on delivering high-quality care.
Key features of Prevounce APCM support:
- APCM-compliant software: Our platform ensures all documentation and billing practices meet CMS requirements.
- Patient and staff support: Our team provides training, resources, and continuous support to ensure your APCM program’s success.
Simplifying APCM Setup and Success
Setting up APCM services is a strategic investment in patient care and practice growth. By following these steps, your practice can establish a strong foundation for delivering comprehensive care management that benefits both patients and providers. For more support in launching APCM services, contact Prevounce today and learn how our platform can make APCM setup and management efficient and compliant.
Learn More During Our APCM Crash Course
If your organization provides or is considering delivering remote care management services, you will want to learn about the new Advanced Primary Care Management (APCM) program. We'll dive into APCM in our upcoming 30-minute webinar, "Crash Course on Advanced Primary Care Management," on Jan. 9, 2025, 2:00 PM ET / 11:00 AM PT. Reserve your seat for this special event!