APCM Billing Setup Checklist for NextGen Healthcare

Add G0511, G0512, and G0513 to the Service Item Master File and link them to the appropriate specialty fee schedules.

Add modifiers like -25 or -59 to the Master File to prevent bundling denials during same-day visits within the PM.

If applicable, ensure APCM codes map to the correct 052x revenue codes for institutional billing to avoid claim rejections.

Set up rules in File Maintenance to trigger APCM billing alerts based on insurance-specific requirements for chronic care.

Create specific billing workgroups in the PM to track unpaid APCM claims separately from standard E/M visits.

Update the Care Management module to include mandatory APCM fields for chronic condition tracking and care plan updates.

Use NextGen Population Health tools to filter and flag patients meeting the two or more chronic condition criteria.

Ensure the EHR timer captures non-face-to-face time spent on patient coordination and AI-assisted call handling.

Enable the Share to Portal feature to meet CMS requirements for providing patients with a 24/7 accessible care plan.

Sync AI-powered call center logs directly into the NextGen EHR encounter to document patient outreach and coordination.

Use NextGen Report Writer to create a dashboard tracking monthly billable minutes per patient to ensure thresholds are met.

Perform weekly audits of APCM encounters to ensure incident to supervision requirements are clearly documented.

Verify that interactions via NextGen Mobile are correctly pulling into the APCM billing worklist for clinicians.

Run reports to ensure modifiers are correctly applied to prevent claim rejections for bundled services.

Use a custom field or the Consent tab in NextGen to document and verify verbal or written APCM enrollment.

Configure the API to push call duration and summary data from the AI assistant into the PM encounter for billing.

Set up AI voice flows to contact eligible patients identified in NextGen Pop Health for APCM enrollment.

Use AI call outcomes to automatically generate tasks in the NextGen Tasking module for clinical staff follow-up.

Log all after-hours AI interactions to satisfy the CMS 24/7 access requirement for APCM documentation.

Ensure AI call center updates to patient phone numbers are reflected in the NextGen PM demographics automatically.