Setting Up APCM Services in Your Practice

Assessing Patient Eligibility and Care Needs

Implementing APCM effectively begins with assessing your patient population to identify those who could benefit most from this service. The criteria set by CMS primarily focuses on chronic conditions, and APCM services are tailored to patients with varying degrees of care needs, from stable chronic conditions to those requiring complex, multidisciplinary management.

Patient eligibility: Medicare patients with zero, one, or multiple chronic condition(s) may qualify for APCM, making the program essentially available to all Medicare enrollees. More specific billing codes are available for patients with two or more chronic conditions or Qualified Medicare Beneficiary status.

Use of EHR and screening tools: Many practices use electronic health records (EHRs) to identify APCM-eligible patients automatically, particularly those who may benefit from ongoing care management, including frequent hospital visits or medication adherence challenges.

Understanding billing codes for different levels of care: Different APCM billing codes (G0556, G0557, G0558) support varying levels of care, so be sure to match each patient's needs to the correct code for accurate billing and compliance

Creating a Comprehensive Care Plan

Each APCM patient must have a personalized care plan that addresses their specific health needs, goals, and treatment priorities. An effective APCM care plan includes elements designed to guide the care team in delivering consistent, goal-oriented support.

Key components of an APCM care plan:

Individualized health goals: Set clear, measurable goals for the patient, focusing on chronic condition management, preventive measures, and functional improvement.

Patient assessment and ongoing evaluation: Begin with a thorough assessment of the patient’s physical, mental, and social needs, and include routine reassessments to update the care plan based on progress or new challenges.

Multidisciplinary team collaboration: Identify the roles of each care team member (e.g., nurses, social workers) to ensure that all aspects of the patient’s care are coordinated effectively. Documentation of these roles also aids compliance and keeps team communication efficient.

Patient Education and Engagement Strategies

A successful APCM program relies heavily on patient engagement. Educating patients about the benefits of APCM and setting clear expectations for participation help to create an open line of communication and build trust.

Explain APCM benefits and responsibilities: Patients should understand the benefits of APCM, such as improved access to their care team, more structured care, and proactive health management.

Use accessible communication methods: Consider using secure patient portals, email, or text reminders to engage patients effectively. Regular reminders keep patients connected to their care plans, helping them stay adherent to treatment instructions and routine check-ins.

Encourage patient feedback: Feedback can provide valuable insights into the patient’s experience with APCM, helping practices refine their engagement strategies. Regular feedback loops also improve patient satisfaction and strengthen the patient-provider relationship.

Here is a short video covering the key information to know before getting started: