APCM Billing Code Setup Checklist for ACOs | MSSP Success

Ensure your chargemaster is updated with the specific G-codes required for Advanced Primary Care Management for ACO-assigned beneficiaries.

Check if your specific MSSP track requires unique modifiers to distinguish APCM services from standard chronic care management.

Coordinate with all participating practices to ensure billing cycles are aligned, preventing duplicate claims within the same month.

Set up reporting to track how APCM fee-for-service revenue offsets the costs of centralized care coordination staff.

Set automated alerts in your billing software to trigger when the minimum time requirement for APCM codes has been met.

Use AI call handling to automatically record and time-stamp every minute of care coordination conducted over the phone.

Configure AI voice assistants to obtain and document patient consent for APCM services, storing the recording in the EHR.

Use AI to transcribe care coordination calls directly into the patient's record to satisfy CMS documentation requirements.

Enable AI to flag when a patient interaction necessitates a care plan update, ensuring billing reflects active management.

Use AI-generated reports to audit all non-face-to-face time to ensure billing accuracy before claim submission.

Ensure that the activities billed under APCM codes directly support quality measures like blood pressure and diabetes control.

Use AI to call patients with outstanding care gaps and document the interaction as billable APCM time.

Trigger automated AI follow-up calls after hospital discharge to reduce readmissions, a key metric for MSSP savings.

Establish a dashboard to compare the Total Cost of Care (TCOC) for patients enrolled in APCM versus those who are not.

Ensure all ACO participants use a unified care plan template that meets both APCM and ACO quality reporting needs.