APCM Billing Code Setup Checklist for Epic EHR

Configure the Patient Action Framework to pull data from the Problem List and Encounter history for chronic conditions.

Use SQL-based Clarity reporting to identify gaps in care and potential APCM enrollment opportunities across the system.

Set up real-time BPA alerts for clinicians to discuss APCM enrollment during regular office visits in Hyperspace.

Validate that all relevant chronic conditions are correctly flagged within the Epic metadata fields for registry inclusion.

Prevent duplicate billing by excluding patients enrolled in Hospice or ESRD programs directly within the registry logic.

Add specific CMS APCM G-codes to your Epic EAP master file with correct pricing and department mapping.

Define rules to ensure APCM charges are sent to the correct professional or hospital billing office based on location.

Design interactive forms that capture start/stop times and calculate total monthly care minutes for APCM billing.

Ensure all APCM activities are documented under a specific 'Care Management' encounter type code for clean claims.

Utilize Epic's automated billing triggers to drop charges once time thresholds are met, reducing manual entry.

Link your AI call center to Epic via Interconnect to automatically document outreach attempts in the patient chart.

Use the MyChart portal to distribute, sign, and store APCM patient consent forms electronically in the media tab.

Create .APCMCAREPLAN SmartPhrases to ensure all documentation meets CMS regulatory standards across the care team.

Route AI-generated call summaries to specific provider pools or care managers for review and sign-off.

Ensure AI-handled phone coordination is captured as a billable interaction within the Epic Care Management module.