Workflow GuideeClinicalWorks

APCM Billing & Claims Workflow for eClinicalWorks | Tile Health

Master APCM billing in eClinicalWorks. Learn to configure modules, track time, and automate claims submission for primary care management.

Optimizing Advanced Primary Care Management (APCM) billing within eClinicalWorks requires a precise alignment of the CCM module, registry settings, and claim generation workflows. This guide details how to leverage eCW's internal tools alongside Tile Health AI-powered call automation to ensure every billable minute is captured and submitted accurately.

The Challenge

Many eCW practices fail to capture full APCM revenue due to manual time-tracking gaps, complex ICD-10 mapping requirements, and the administrative burden of documenting non-face-to-face patient interactions within the EHR.

Step-by-Step Workflow

1

Configure the APCM Registry in eCW

Access the Population Health module to define patient cohorts based on chronic condition codes and risk scores. Ensure the APCM-specific registry is filtered to include only eligible primary care patients to avoid claim denials and ensure proper enrollment status.

Best Practices
  • Use the 'Registry Query' tool to bulk-identify patients.
  • Filter by ICD-10 codes relevant to APCM guidelines.
Common Pitfalls
  • Failing to update the registry as new patients are onboarded.
2

Map APCM Procedure Codes in Billing Setup

Navigate to the Billing tab and add the specific APCM CPT codes to your practice's favorites list. Ensure these codes are mapped to the correct fee schedule to automate the 'Claim Scrubber' process and prevent manual entry errors at the point of care.

Best Practices
  • Check the 'Auto-Populate' box for APCM codes in encounter templates.
  • Cross-reference codes with current CMS APCM reimbursement schedules.
Common Pitfalls
  • Using generic CCM codes instead of the new APCM-specific identifiers.
3

Deploy AI Call Handling for Time Tracking

Integrate Tile Health’s AI call handlers with eCW via API to automatically log patient interaction duration. The AI handles routine check-ins and pushes the time-spent data directly into the eCW 'Time Capture' log to meet the 20-minute monthly threshold.

Best Practices
  • Enable the 'Auto-Log' feature for inbound patient inquiries.
  • Set alerts for patients nearing the monthly time threshold for billing.
Common Pitfalls
  • Manual entry of call times, which leads to consistent under-reporting of care time.
4

Document Care Coordination in eCW Templates

Utilize custom SmartForms or templates within the Progress Note to document non-face-to-face care. Ensure the 'Care Plan' section is updated and synced with the patient portal to meet APCM documentation requirements for CMS audits.

Best Practices
  • Create a 'Quick Launch' button for APCM documentation in the progress note.
  • Use the 'Merge' function to pull data from previous care management encounters.
Common Pitfalls
  • Leaving the Care Plan section blank or failing to sync it with the eCW portal.
5

Generate and Scrub APCM Claims

Use the eCW 'Claim Dashboard' to batch-generate claims for the APCM registry. Run the built-in Claim Scrubber to identify missing modifiers or incorrect provider NPIs before electronic submission to the clearinghouse.

Best Practices
  • Run the scrubber daily to avoid month-end submission bottlenecks.
  • Verify that the 'Date of Service' reflects the calendar month end for recurring billing.
Common Pitfalls
  • Submitting claims without verifying the 20-minute minimum documentation threshold.
6

Reconcile Payments via ERA

Review Electronic Remittance Advices (ERA) within the eCW 'Payments' module to track APCM reimbursements. Address any 'Reason Codes' for denials immediately to refine registry filters or documentation workflows for the next billing cycle.

Best Practices
  • Set up a custom report to track APCM ROI and capture rates.
  • Automate the posting of APCM payments to the patient ledger.
Common Pitfalls
  • Ignoring small-balance denials that indicate systemic setup errors in the billing module.

Expected Outcomes

1

Increased APCM capture rate through automated time logging

2

Reduction in claim denials via eCW Scrubber optimization

3

Lower administrative overhead for primary care staff

4

Improved compliance with CMS documentation standards

5

Enhanced patient engagement via AI-integrated call workflows

Frequently Asked Questions

eCW uses the 'Time Capture' module which can be manually updated or integrated with external AI tools like Tile Health to automatically log interaction duration directly from patient phone calls.

Yes, but you must configure new CPT codes and modify the registry filters within the Population Health module to align with APCM-specific eligibility and reimbursement rules.

Utilize eCW SmartForms to create a standardized APCM note that includes care plan updates, coordination activities, and time spent, all of which are timestamped within the EHR.

Tile Health integrates via API to push interaction logs into the eCW 'Time Capture' log, which then feeds into the billing module for automated claim generation.

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APCM Billing & Claims Workflow for eClinicalWorks | Tile Health | Tile Health