APCM Billing Setup Checklist for Geriatric Practices

Verify Medicaid-dual eligibility to bill the higher-tier G0558 code for qualified low-income seniors.

Flag patients on 5+ medications to justify high-complexity APCM enrollment and frequent medication reviews.

Document baseline cognitive scores (MMSE/MoCA) to determine if a caregiver must be the primary point of contact.

Review past 12 months of falls to prioritize APCM check-ins focused on home safety and mobility.

Use AI intake to identify isolation or food insecurity, which are required data points for comprehensive geriatric care plans.

Update HIPAA authorizations to allow AI call assistants to discuss APCM care plans with family members or legal guardians.

Set up AI logic to route potential fall-related calls or acute confusion directly to the on-call geriatrician to prevent ER visits.

Schedule AI-driven calls to satisfy the monthly APCM contact requirement for G0557/G0558 billing.

Ensure all phone-based caregiver interactions are automatically transcribed and time-stamped for audit-proof billing.

Simplify phone menus with slow, clear speech and minimal options to accommodate patients with mild cognitive impairment.

Include sections for end-of-life planning and advanced directives, which are essential for geriatric APCM.

Integrate mandatory screening questions into the initial APCM enrollment call handled by the AI system.

Link hospital discharge alerts to the APCM workflow to trigger immediate post-acute follow-up calls.

Document a monthly review of all prescriptions and OTC supplements during the APCM check-in cycle.

Keep records of communication with AL/SNF staff regarding medication changes or mobility assessments.