Question 1

How do we identify APCM-eligible patients within Epic?

Accepted Answer

Eligibility identification is best handled through the Epic Reporting Workbench or SlicerDicer. You must build a registry using specific SmartData Elements (SDEs) that filter for chronic conditions, visit frequency, and insurance coverage. Tile Healthcare's AI integrates with these registries to prioritize outreach to high-risk patients who meet the CMS criteria for APCM services.

Question 2

Can Epic registries automatically update enrollment status?

Accepted Answer

Yes, by utilizing Epic's Workflow Engine rules, you can automate status changes within the registry. For example, once a patient provides verbal consent and it is documented via a specific SmartText template, the registry status can transition from 'Eligible' to 'Enrolled' automatically, triggering the appropriate care management activity.

Question 3

What Epic SmartData Elements are required for APCM?

Accepted Answer

To track APCM effectively, you should configure SDEs for 'Consent Date', 'Care Plan Last Reviewed', and 'Monthly Time Spent'. These elements allow for discrete data capture that can be pulled into both Reporting Workbench reports and the billing module to ensure all CMS requirements are met before a claim is generated.

Question 4

How do we handle patient deduplication across multiple Epic registries?

Accepted Answer

Epic's Registry Framework allows for priority logic. You should configure your APCM registry to take precedence or link with CCM (Chronic Care Management) registries to ensure patients are not enrolled in conflicting programs, which would lead to billing denials under CMS guidelines.

Question 5

How can MyChart be utilized for APCM enrollment?

Accepted Answer

MyChart can be used to send automated APCM invitation questionnaires. Patients can review the program benefits and provide electronic signatures for consent. If a patient does not respond to the MyChart message, Tile Healthcare’s AI call center can automatically initiate a follow-up call to explain the program and capture verbal consent.

Question 6

How is verbal consent documented in Epic for APCM?

Accepted Answer

Verbal consent should be documented using a standardized Epic SmartForm or a SmartText template within a Telephone Encounter or Care Management note. This documentation must include the date, the clinician's name, and a statement that the patient was informed of their right to stop services at any time.

Question 7

Can we automate the 'APCM Enrolled' flag in the patient header?

Accepted Answer

Yes, using Epic's Storyboard configuration, you can display a visual indicator or 'flag' when a patient is active in the APCM program. This is triggered by a specific status in the patient's Care Management registry, ensuring that every clinician who opens the chart is aware the patient is receiving coordinated care.

Question 8

What happens if a patient opts out of APCM via MyChart?

Accepted Answer

When a patient opts out via a MyChart questionnaire, the response should trigger an InBasket message to the Care Coordination pool. The system should be configured to automatically update the registry status to 'Declined,' which halts all automated AI outreach and prevents accidental billing.

Question 9

Which Epic modules support APCM billing codes?

Accepted Answer

APCM billing is primarily handled through Epic Resolute Professional Billing. You must ensure that the new G-codes for APCM are added to your Fee Schedule and that Charge Router rules are in place to validate that the required 20 minutes of non-face-to-face care have been documented before the charge is dropped.

Question 10

How does Epic track the time requirement for APCM billing?

Accepted Answer

Time tracking is typically managed through Epic Flowsheets or the 'Time Capture' activity. Clinicians and AI-integrated tools log minutes spent on care coordination. At the end of the calendar month, a billing workqueue can aggregate these minutes to determine if the 20-minute threshold for APCM billing has been reached.

Question 11

Can AI call logs automatically populate Epic billing notes?

Accepted Answer

Yes, through FHIR API or HL7 integrations, Tile Healthcare's AI logs call duration and summaries directly into the Epic encounter. This data populates the necessary flowsheets, ensuring that the time spent on the phone by the AI counts toward the monthly APCM billing requirement without manual data entry.

Question 12

How do we prevent double-billing APCM and CCM in Epic?

Accepted Answer

Hard stops should be implemented in the Epic billing workqueue. These 'Best Practice Advisories' (BPAs) alert the billing team if a claim for APCM (G-codes) and CCM (99490) are submitted for the same patient in the same service period, preventing compliance risks and audit triggers.

Question 13

How does AI call handling reduce the Epic documentation burden?

Accepted Answer

Manual outreach requires staff to open encounters, type notes, and update registries. Tile Healthcare's AI automates this by performing the outreach and then using Epic's APIs to write the summary directly into the patient's chart, updating the registry status and time logs automatically based on the conversation.

Question 14

Can AI trigger MyChart messages based on call results?

Accepted Answer

Absolutely. If an AI call identifies a specific patient need—such as a medication refill—it can trigger an automated MyChart message to the patient or an InBasket message to the clinical team, ensuring that the loop is closed within the Epic ecosystem.

Question 15

How does Tile Healthcare integrate with Epic's App Market?

Accepted Answer

Tile Healthcare utilizes secure OAuth2 authentication and standard API endpoints available through the Epic App Market (formerly App Orchard). This allows for seamless data exchange between our AI call handling system and your Epic instance while maintaining strict HIPAA compliance.

Question 16

What is the benefit of AI-driven outreach over manual Epic workqueues?

Accepted Answer

Manual workqueues often lead to 'alert fatigue' and missed opportunities. AI-driven outreach proactively contacts patients for APCM enrollment and monthly check-ins, only escalating to the Epic InBasket when a human clinician's intervention is actually required, significantly increasing program scale.

APCM Billing & Enrollment for Epic EHR: FAQ Guide

Patient Identification & Registry Setup

Enrollment & MyChart Integration

Billing & Documentation Workflows

AI & Communication Integration

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