APCM Billing Setup Checklist for Solo Medical Practices

Ensure your individual NPI is active and correctly associated with your solo practice's Tax ID for billing.

Verify active status in PECOS to ensure eligibility for Advanced Primary Care Management billing cycles.

Formally designate the solo physician as the primary billing entity to meet CMS requirements for APCM.

Scan your EHR for patients with two or more chronic conditions and active Medicare Part B coverage.

Ensure your practice is not enrolled in conflicting CMS programs like ACO Reach that might limit APCM billing.

Manually add G0511 and relevant APCM codes to your practice management system’s master fee schedule.

Establish written protocols for AI-assisted care coordination to satisfy CMS incident-to billing requirements.

Link your AI call center platform to your EHR to automatically log non-face-to-face interaction minutes.

Set up billing software to automatically append necessary modifiers for remote care management services.

Create a dedicated, searchable field in your EHR to document patient consent for APCM services.

Configure the AI call center to handle routine care management inquiries and log time spent per patient.

Develop standardized care plan templates that the AI can help populate based on patient interactions.

Define which patient alerts require solo physician intervention versus those handled by AI automation.

Set up automated monthly reports that aggregate care coordination time for easy billing reconciliation.

Ensure the AI platform provides a timestamped log of after-hours access to meet CMS availability standards.

Use a solo-practice ROI calculator to set monthly enrollment goals for your 300+ Medicare patients.

Maintain a secure digital archive of all AI-generated care logs and physician review timestamps.

Schedule APCM billing cycles to occur once per calendar month after the 20-minute threshold is met.

Create a specific workflow for solo providers to review and resubmit any rejected APCM codes efficiently.

Document the physician's monthly review of automated care management activities to ensure clinical oversight.