Question 1

Which Atrial Fibrillation patients are eligible for APCM enrollment?

Accepted Answer

Patients with chronic Atrial Fibrillation who require ongoing monitoring of anticoagulation or rate and rhythm control are eligible. This typically includes those with a CHA2DS2-VASc score requiring therapy or those post-ablation who need structured long-term follow-up to prevent recurrence and manage stroke risk.

Question 2

How does AI automation facilitate the APCM enrollment process?

Accepted Answer

Tile Healthcare’s AI call system can reach out to your existing AFib patient roster to explain the benefits of Advanced Primary Care Management, screen for eligibility, and capture verbal consent, which is then logged directly into your EHR to satisfy CMS documentation requirements.

Question 3

Is a face-to-face visit required before starting AFib APCM?

Accepted Answer

Yes, CMS requires an initiating visit for new patients or those not seen within a year. During this visit, the provider must establish the AFib care plan, including anticoagulation strategy and rhythm management goals, before billing for subsequent APCM services.

Question 4

Can patients with both AFib and Heart Failure be enrolled?

Accepted Answer

Absolutely. Patients with co-occurring AFib and Heart Failure are high-priority candidates for APCM. Managing the interplay between these conditions, such as fluid volume status and heart rate control, requires the frequent touchpoints that AI-powered monitoring provides.

Question 5

What documentation is necessary to support an AFib APCM claim?

Accepted Answer

Documentation must include the comprehensive care plan, evidence of 24/7 access to care, and logs of non-face-to-face time spent managing the patient's AFib, such as reviewing INR levels or adjusting DOAC dosages based on renal function changes.

Question 6

How do we track billable time for AFib anticoagulation management?

Accepted Answer

All time spent by clinical staff reviewing AI-generated reports on medication adherence, INR results, or symptom changes counts toward the monthly APCM requirements. Tile Healthcare provides detailed logs of patient interactions to simplify this tracking for your billing team.

Question 7

Does APCM billing cover post-ablation follow-up calls?

Accepted Answer

Yes, structured follow-up for post-ablation patients is a core component of APCM. Monitoring for early recurrence of AFib or procedural complications via automated AI check-ins ensures high-quality care that is fully reimbursable under APCM codes.

Question 8

How does AI help meet MIPS quality measures for Atrial Fibrillation?

Accepted Answer

AI automation ensures consistent screening for anticoagulation contraindications and regular CHA2DS2-VASc score updates. By systematically collecting this data, practices can easily report on MIPS measures related to stroke prevention and therapy.

Question 9

What are the common reasons for AFib APCM claim denials?

Accepted Answer

Denials often stem from insufficient documentation of the care plan or overlapping billing with other care management services. Using a dedicated AI platform ensures that all AFib-specific interactions are timestamped and clinical goals are clearly mapped to the patient's record.

Question 10

Can we bill for APCM if the patient is using a remote cardiac monitor?

Accepted Answer

Yes, APCM can be billed alongside Remote Physiologic Monitoring (RPM) for AFib, provided the documentation shows distinct clinical activities for each service, such as managing the medication response to the rhythm data captured by the monitor.

Question 11

How does the AI handle warfarin INR monitoring workflows?

Accepted Answer

The AI call center automatically contacts patients to remind them of lab appointments and can follow up to deliver dosage adjustments prescribed by the provider. This reduces the heavy administrative burden on cardiology nursing staff while ensuring patient safety.

Question 12

What happens when an AFib patient reports palpitations to the AI?

Accepted Answer

Tile Healthcare’s AI uses clinical protocols to triage symptoms. If a patient reports palpitations, chest pain, or dizziness, the system immediately flags the encounter as urgent and can live-transfer the call to your triage nurse for immediate intervention.

Question 13

How does automation improve DOAC medication adherence?

Accepted Answer

For patients on DOACs like Eliquis or Xarelto, consistent adherence is critical for stroke prevention. AI-powered check-ins verify that patients are taking their medication correctly and identify barriers such as cost or side effects before they lead to non-compliance.

Question 14

Can the AI assist with cardioversion pre-procedure protocols?

Accepted Answer

Yes, the AI can manage the critical three-week pre-cardioversion window by verifying daily anticoagulation adherence, ensuring the patient is therapeutically prepared for the procedure and reducing the risk of last-minute clinical cancellations.

Question 15

How are CHA2DS2-VASc scores updated through the AI system?

Accepted Answer

During routine APCM check-in calls, the AI asks targeted questions about new diagnoses like hypertension or diabetes. Any changes are flagged for the provider to reassess the stroke risk score and adjust the anticoagulation care plan accordingly in the EMR.

APCM Billing & Enrollment for AFib: Cardiology FAQ Guide

Enrollment & Eligibility

Billing & Documentation

Clinical Monitoring Workflow

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