Workflow GuideAthenahealth

Athenahealth APCM Care Plan Creation: Complete Workflow Guide

Master the APCM care plan creation workflow in athenahealth. Learn to configure athenaOne, automate outreach, and bill G0556-G0558 codes efficiently.

Implementing Advanced Primary Care Management (APCM) within athenahealth requires a precise blend of clinical documentation and administrative automation. This guide outlines how to leverage athenaOne's native care management features alongside AI-powered outreach to create, manage, and bill for comprehensive care plans for your chronic care patient population.

The Challenge

Many independent practices struggle to transition from traditional CCM to APCM within athenahealth. Fragmented workflows, difficulty identifying eligible patients via custom reports, and the manual burden of care plan updates often lead to missed billing opportunities for codes G0556-G0558.

Step-by-Step Workflow

1

Identify Eligible Patients via Report Builder

Utilize the athenahealth Report Builder to filter your patient population for those with two or more qualifying chronic conditions. Filter by recent visit history and existing care management status to build your initial APCM target list for outreach.

Best Practices
  • Save the report as a 'Scheduled Report' to receive weekly updates on newly eligible patients.
  • Filter by primary insurance to prioritize CMS-eligible patients.
Common Pitfalls
  • Failing to exclude patients already enrolled in traditional CCM workflows.
2

Configure athenaOne Care Management Templates

Access the 'Settings' menu in athenaOne to customize your Care Management templates. Ensure the template includes mandatory APCM fields such as clinical goals, expected outcomes, and identified barriers to care to satisfy CMS audit requirements.

Best Practices
  • Use 'Macros' within athenaOne to speed up the documentation of standard care plan components.
  • Link the template to the 'Care Management' section of the patient's chart.
Common Pitfalls
  • Using generic clinical templates that lack the specific SDOH and goal-setting fields required for APCM.
3

Automate Patient Consent and Enrollment

Deploy AI-powered call handling to reach out to the identified patient list. The AI can explain the APCM program benefits, verify patient interest, and obtain verbal consent, which is then logged directly into the athenaOne 'Patient Note' or 'Communication' tab.

Best Practices
  • Ensure the AI script clearly mentions the patient's right to opt-out at any time.
  • Use athenahealth Marketplace integrations to sync call logs automatically.
Common Pitfalls
  • Relying on manual staff calls, which often results in low enrollment rates due to time constraints.
4

Conduct the Comprehensive Assessment

Perform the initial assessment using the athena clinical encounter. Utilize the 'Social Determinants of Health' (SDOH) screeners within athenaOne to capture risk factors that will inform the specific interventions in the APCM care plan.

Best Practices
  • Map SDOH responses to the 'Problem List' to ensure clinical visibility.
  • Use the 'Review of Systems' section to document chronic condition stability.
Common Pitfalls
  • Skipping the SDOH assessment, which is a critical component of APCM risk stratification.
5

Finalize and Share the Care Plan

Complete the care plan within athenaOne and publish it to the Patient Portal. CMS requires that the care plan be accessible to the patient; ensure your athenaCommunicator settings are configured to notify the patient when the plan is available.

Best Practices
  • Print a hard copy for patients who do not use the portal during their in-office visits.
  • Use the 'Share with Patient' checkbox in the athena clinical document.
Common Pitfalls
  • Creating the plan in athena but failing to provide a copy to the patient or their caregiver.
6

Set Up APCM Billing Rules in athenaCollector

Configure billing rules in athenaCollector to automatically flag encounters with G0556, G0557, or G0558. Ensure that the 'Time Spent' or 'Complexity' documentation is linked to the claim to prevent denials during the claim scrubbing process.

Best Practices
  • Create a 'Billing Picklist' specifically for APCM codes to reduce coder error.
  • Verify that the provider's NPI is correctly associated with the APCM service.
Common Pitfalls
  • Billing APCM codes alongside prohibited CCM codes in the same calendar month.
7

Implement Continuous AI Monitoring

Use automated AI follow-ups to check in on patient progress against care plan goals. The AI can collect data on medication adherence or symptom changes, feeding this information back into the athenaOne chart for the provider to review.

Best Practices
  • Schedule AI follow-ups every 30 days to maintain APCM engagement requirements.
  • Set up 'Task' alerts in athena for providers when AI detects a barrier to care.
Common Pitfalls
  • Treating the care plan as a one-time document rather than a dynamic, updated record.

Expected Outcomes

1

Seamless integration of APCM documentation within existing athenaOne workflows.

2

Increased capture rate of G0556-G0558 billing codes through automated eligibility reporting.

3

Improved patient engagement via automated AI outreach and portal-integrated care plans.

4

Reduction in administrative overhead for clinical staff through streamlined documentation templates.

5

Full compliance with CMS APCM requirements and athenahealth billing protocols.

Frequently Asked Questions

Ensure your practice's fee schedule is updated with G0556, G0557, and G0558. You can search for these in the 'Billing' tab under 'Procedure Codes' or add them to your common encounter templates for easy selection.

Yes, once the care plan is finalized in the clinical encounter, it can be published to the athenahealth Patient Portal. You should also ensure athenaCommunicator is set up to send an email or text alert to the patient.

AI tools handle the high volume of monthly outreach and consent calls required for APCM. By integrating with the athenahealth Marketplace, these tools can sync call notes and patient responses directly into the chart, saving staff hours of manual data entry.

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Athenahealth APCM Care Plan Creation: Complete Workflow Guide | Tile Health