Workflow GuideAdvancedMD

AdvancedMD APCM Billing & Claims Submission Workflow

Optimize your APCM billing in AdvancedMD. Learn how to configure G-codes, identify eligible patients, and automate claims submission for maximum revenue.

Implementing Advanced Primary Care Management (APCM) in AdvancedMD offers independent practices a significant revenue stream, but success requires precise billing configuration. This guide details the step-by-step workflow for setting up G-codes, identifying eligible patients via AdvancedMD analytics, and leveraging AI automation to ensure documentation meets CMS requirements for seamless claim...

The Challenge

Many AdvancedMD users struggle with manual G-code entry and tracking the monthly service threshold, leading to denied claims and lost revenue for APCM services due to documentation gaps and configuration errors in the billing module.

Step-by-Step Workflow

1

Configure APCM G-Codes in Master Files

Access the Master Files in AdvancedMD to add specific APCM G-codes (such as G0511 or primary care-specific codes) to your Charge Code library. Ensure correct pricing and RVU values are mapped to prevent front-end scrubbing errors during claim creation.

Best Practices
  • Double-check the effective date for new codes.
  • Map codes to the correct financial class.
Common Pitfalls
  • Using outdated CPT codes instead of the specific G-codes required for APCM.
2

Set Up Patient Eligibility Filters in Analytics

Use the AdvancedMD Reporting and Analytics module to build a custom filter for patients with two or more chronic conditions. This identifies your APCM-eligible population automatically, allowing for targeted outreach via the patient engagement tool.

Best Practices
  • Filter by ICD-10 codes for chronic conditions.
  • Save the report for monthly recurring use.
Common Pitfalls
  • Relying on manual chart reviews instead of using system-wide analytics.
3

Integrate AI-Powered Outreach for Enrollment

Deploy an AI call center to contact eligible patients identified in your AdvancedMD reports. The AI handles the heavy lifting of explaining APCM benefits, obtaining consent, and updating the 'Patient Note' field in AdvancedMD to signal enrollment.

Best Practices
  • Sync AI call logs directly to the patient dashboard.
  • Capture verbal consent during the automated call.
Common Pitfalls
  • Forgetting to document the initial enrollment consent in the permanent record.
4

Document Time-Based Services in EHR Templates

Create a specific 'APCM Note' template within the AdvancedMD EHR. Ensure it includes a dedicated field to track the cumulative minutes spent on non-face-to-face care coordination to satisfy CMS audit requirements for the 20-minute threshold.

Best Practices
  • Use macros for common care coordination tasks.
  • Enable the 'Time Tracking' feature if available in your EHR version.
Common Pitfalls
  • Vague documentation that doesn't specify 'non-face-to-face' time.
5

Automate Charge Capture and Claim Scrubbing

Link your APCM templates to the billing module so that charges are automatically captured once the time threshold is met. Run the AdvancedMD Claim Inspector to catch any missing modifiers or provider information before the claim is sent.

Best Practices
  • Set up a billing rule for G-code frequency.
  • Review the 'Unbilled Charges' report weekly.
Common Pitfalls
  • Submitting claims without verifying the 20-minute minimum has been logged.
6

Monitor APCM Revenue via Dashboards

Utilize the AdvancedMD Dashboard to track APCM reimbursement trends. Monitor the 'Days in AR' for APCM G-codes to identify if specific payers are delaying payments for these newer service lines compared to standard E/M codes.

Best Practices
  • Compare APCM revenue against outreach costs.
  • Set up automated monthly revenue reports.
Common Pitfalls
  • Ignoring high denial rates for APCM codes during the first 90 days.

Expected Outcomes

1

Increased monthly recurring revenue from APCM services

2

Reduced administrative burden through automated patient identification

3

Higher claim acceptance rates for G-code submissions

4

Improved documentation compliance for CMS audits

5

Enhanced patient engagement via AI-driven outreach

Frequently Asked Questions

The primary codes are G0511 for RHC/FQHC or specific G-codes for primary care practices; ensure these are added to your AdvancedMD Charge Code library before billing.

While AdvancedMD doesn't have a native 'stopwatch' for all tasks, custom templates with time-tracking fields can be used to aggregate total monthly care time for billing.

AI handles the time-consuming task of patient outreach and consent, ensuring your billable pipeline is always full without increasing staff overhead or manual data entry.

Ready to transform your advancedmd practice?

See how Tile Healthcare's AI call center can handle scheduling, triage, and patient communication for your practice.

Schedule a Demo
AdvancedMD APCM Billing & Claims Submission Workflow | Tile Health