APCM Billing Code Setup for Concierge & DPC Practices
Optimize your Concierge or DPC practice with our APCM billing code setup checklist. Learn to stack membership fees with Medicare revenue efficiently.
For concierge and DPC practices, Advanced Primary Care Management (APCM) represents a powerful revenue stack. This checklist ensures your billing system is configured to capture Medicare revenue alongside membership fees without violating regulatory standards or compromising the high-touch patient experience your affluent panel expects.
Work through each item below to audit your practice. Check off completed items to track where you stand.
Regulatory & Compliance Alignment
Ensure your practice model adheres to Medicare and state-specific DPC regulations before initiating APCM billing.
EHR & Billing System Configuration
Technical setup within your practice management software to track and submit APCM claims accurately.
Workflow & Patient Communication
Operationalizing the APCM model to ensure consistent care delivery and documentation for small patient panels.
Frequently Asked Questions
Yes, provided you have not opted out of Medicare and are operating a hybrid model where you bill Medicare for covered services while charging a membership fee for non-covered amenities.
APCM is designed as a more holistic primary care bundle that aligns better with the comprehensive care delivery model of concierge medicine compared to the task-based CCM codes.
Yes, the time spent by clinical staff reviewing AI-generated summaries, as well as the AI-facilitated care coordination itself, can be documented toward the monthly time requirements.
Because concierge patients often have Medigap or secondary insurance, the co-insurance is usually covered. However, you must inform patients of potential costs during the consent process.
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