Athenahealth APCM Billing Code Setup Checklist

Ensure your templates include specific fields for chronic condition management and care plan updates to satisfy CMS audit trails.

Map specific athenaOne fields to capture the patient-centered care plan goals required for G0556-G0558 billing.

Streamline the encounter by creating order sets that include common screenings and referrals associated with primary care management.

Link the new APCM billing codes to the relevant clinical sections in athenaOne to ensure the billing team receives accurate signals.

Utilize athenaOne's built-in timers or integrated AI tools to document the cumulative time spent on non-face-to-face care.

Use the 'Goals' section in the patient chart to track progress on chronic conditions, which is a key component of APCM documentation.

Input codes G0556, G0557, and G0558 into your athena fee schedule with appropriate pricing for your region and payer contracts.

Set up rules in the athenahealth rules engine to catch duplicate billings or missing diagnosis codes before the claim is sent.

Customize how different insurance carriers handle APCM codes to minimize denials and ensure consistent reimbursement.

Ensure that the billing configuration correctly attributes the APCM service to the patient's primary care provider of record.

Review the 'Billing Admin' section to ensure that care management services are not being bundled incorrectly with other E/M codes.

Run a test batch of claims to ensure the 837P electronic format correctly transmits the G-series codes to the clearinghouse.

Use athenahealth Report Builder to filter for patients with two or more qualifying chronic conditions based on ICD-10 codes.

Generate a monthly list of patients who have not yet had their APCM service billed to ensure no revenue is left on the table.

Refine your reports to exclude inactive or deceased patients, focusing only on those currently enrolled in your primary care panel.

Configure athena to email these eligibility reports to your care management team on the first day of every month.

Regularly check the 'Unbilled' reports to identify encounters that were documented but never moved to the billing stage.

Create a custom chart tab in athenaOne to clearly display a patient's enrollment status in the APCM program for all staff to see.

Connect your AI-powered call handling system to the athenahealth API to allow for real-time data exchange and note posting.

Program the AI to call patients for their monthly check-ins, ensuring the required touchpoints for APCM billing are met consistently.

Ensure that every AI interaction is automatically documented as a 'Phone Note' or 'Encounter' within the athenaOne patient record.

Set up logic where the AI identifies red-flag symptoms during a call and immediately alerts a nurse via an athena task.

Use AI to send text message reminders for care plan adherence, which counts toward the overall management time for APCM.

Deploy AI agents to check the latest eligibility status for APCM coverage, reducing the burden on your front office staff.