Oracle Health APCM Billing & Enrollment FAQ Guide

CMS requires documented consent, a comprehensive care plan, and evidence of 20+ minutes of non-face-to-face care. TileHealthcare's AI logs every second of telephonic care coordination, automatically populating the Cerner activity log to ensure that the cumulative time requirement is met for monthly billing.

Absolutely. Through the Oracle Health Ignite APIs, our AI system pushes call summaries, durations, and patient responses directly into the clinical record. This eliminates the need for manual data entry and ensures that the billing team has immediate access to the documentation needed to drop APCM claims.

G-codes (like G0511 for RHCs/FQHCs or specific APCM codes) must be mapped in the Cerner CDM (Charge Description Master). Our system triggers a 'charge ready' notification in the workflow when the AI-tracked care coordination time exceeds the threshold, signaling the billing office to review and submit the claim.

The transition requires updating the logic in HealtheIntent and PowerChart. AI automation helps manage this shift by screening existing CCM patients for APCM eligibility and conducting the necessary re-consent calls to move them into the more advanced management tier without increasing staff workload.

Yes. Data gathered during AI-led APCM assessments—such as social determinants of health (SDOH) or medication adherence issues—can be pushed back into HealtheIntent. This updates the patient's risk profile in real-time, allowing for more accurate population health management across the health system.

Our AI-powered IVR recognizes the caller's phone number from the Cerner database and identifies them as an APCM-enrolled patient. The call is then prioritized or routed to their dedicated care coordinator, ensuring the '24/7 access to care' requirement of APCM is met efficiently.

By automating the repetitive tasks of patient identification, enrollment outreach, and routine check-ins, clinical staff can focus on high-acuity interventions. The AI handles the 'heavy lifting' of meeting the monthly 20-minute documentation requirement within the Oracle Health workflow.

While PowerChart has basic timers, our AI provides a more robust solution by aggregating all telephonic interaction time. This data is synced with Cerner's 'Care Management' dashboard, providing a clear visual indicator of which patients have met the billing threshold for the current month.

In shared domains, attribution is critical. Our AI uses the 'Primary Care Provider' and 'Assigned Location' fields in Oracle Health to ensure that APCM enrollment and billing are attributed to the correct legal entity, preventing cross-facility billing errors and potential audits.

We provide a comprehensive audit log for every interaction, including the recording (if enabled), a full transcript, and the metadata of the call. This log is linked to the patient's Cerner ID, providing an ironclad defense in the event of a CMS audit of your APCM program.

Oracle Health encourages the use of certified third-party developers via their Ignite program. Our solutions are designed to work within the parameters of Cerner’s certification, ensuring that your use of AI for APCM does not jeopardize your EHR's meaningful use or interoperability status.

Eligibility should be verified monthly before billing. Our AI automation performs a real-time eligibility check through the Oracle Health interface before every scheduled outreach call, ensuring you never perform or bill for services on a patient who has lost coverage or disenrolled.