Article Sections
Overview
Advanced Primary Care Management (APCM) services combine elements of several existing care management and communication technology-based services that helps to simplify billing and documentation requirements while ensuring that patients have access to high-quality primary care services.These services are intended for physicians and non-physician practitioners (NPPs), such as nurse practitioners (NPs), physician assistants (PAs), and clinical nurse specialists (CNSs) who are responsible for delivering and coordinating all of a patient’s primary care services.
APCM Enrollment & Consent
At this time, a patient’s APCM enrollment and consent status is tracked by the manual addition and removal of the default ‘APCM Consent’ patient flag. This flag is able to be added through the same workflows as all other patient flags, either the patient record or any program worklist.
The presence of this flag can also be utilized to filter for a practice’s APCM patients within ThoroughCare’s worklists.
APCM Care Plans
To create a Care Plan for APCM patients, a condition must be associated with the APCM program. These conditions/problems can then be viewed under the Summary of Care tab, or any other program tab that the problem may be associated with.
Note: To populate APCM-related Care Plans onto a patient’s Care Plan Report, the conditions must be associated with at least one other program that is selected to populate on the report. If a condition is not associated with another program, its Care Plan cannot be displayed in the report at this time.
Qualified Medicare Beneficiaries
CMS considers patients who are designated as Qualified Medicare Beneficiaries when reimbursing for Advanced Primary Care Management services. To indicate patients who are considered a Qualified Medicare Beneficiary, a default ‘QMB’ patient flag will be available to manually add to patient records.
APCM Billing & Claims
ThoroughCare supports the following APCM-related CPT Codes: G0556, G0557, and G0558. These monthly claims are generated on the first day of the next month.
Please note, a practice cannot bill for APCM services in the same month as a TCM or CCM claim.
G0556
To generate a G0556 monthly claim on a patient:
Patient must be associated with the ‘APCM Consent’ flag at the time of claim generation
G0557
To generate a G0557 claim:
Patient must be associated with the ‘APCM Consent’ flag
Patient must have 2 or more conditions associated with the APCM program
G0558
To generate a G0558 claim:
Patient must be associated with the ‘APCM Consent’ flag
Patient must be associated with the ‘QMB’ flag
Patient must have 2 or more conditions associated with the APCM program