Workflow GuideGroup Practices

APCM Care Plan Workflow for Group Practices | Tile Healthcare

Scalable APCM care plan creation for multi-physician groups. Standardize workflows and ensure accurate provider attribution with AI automation.

Scaling Advanced Primary Care Management (APCM) across a group practice requires more than just a template; it demands a synchronized infrastructure that handles provider attribution, multi-site coordination, and standardized clinical documentation. This guide outlines a high-efficiency workflow designed for practices with 5 to 50 providers, leveraging AI-driven automation to ensure every patie...

The Challenge

Group practices often struggle with fragmented care plans and inconsistent enrollment across different physicians. Without a centralized system, provider attribution becomes a billing nightmare, and the manual effort to coordinate care management for thousands of patients leads to burnout and mis...

Step-by-Step Workflow

1

Automated Patient Screening and Outreach

Utilize AI-powered call handling to identify eligible patients across all group locations. The AI conducts initial outreach, assesses interest in APCM, and collects baseline health data, filtering high-priority patients for the care management team to reduce manual phone time.

Best Practices
  • Standardize scripts across all sites to maintain group branding
  • Integrate AI outreach with your EHR to flag eligible patients automatically
Common Pitfalls
  • Relying on clinical staff for cold outreach
  • Inconsistent eligibility criteria between different providers
2

Provider Attribution and Verification

Verify the patient's primary billing provider within the group practice to ensure accurate APCM attribution. This step is critical for preventing internal revenue disputes and ensuring compliance with Medicare's billing regulations for group practices.

Best Practices
  • Use historical billing data to confirm the provider with the most frequent visits
  • Document attribution logic clearly for audit purposes
Common Pitfalls
  • Attributing patients to the wrong physician in a multi-specialty group
  • Failing to update attribution when a patient switches primary doctors
3

Centralized Clinical Data Aggregation

Gather medical history, current medications, and lab results from all sites within the group. Use a unified care management platform to create a single source of truth, ensuring that regardless of which office the patient visits, their care plan remains consistent.

Best Practices
  • Appoint a centralized care coordinator to oversee data from multiple sites
  • Standardize chronic condition codes (ICD-10) across the group
Common Pitfalls
  • Maintaining separate care plans for the same patient at different locations
  • Missing medication updates from specialist visits within the group
4

Standardized Care Plan Template Generation

Develop and deploy group-wide care plan templates that meet APCM requirements. These templates should include sections for patient goals, health hurdles, and provider-specific interventions while maintaining a consistent structure for easier administrative oversight.

Best Practices
  • Include a 'shared care' section for multidisciplinary input
  • Automate the population of patient data into the template using AI
Common Pitfalls
  • Allowing providers to create their own non-compliant formats
  • Omitting the required 24/7 access information in the care plan
5

Electronic Consent and Signature Capture

Deploy an automated system to capture patient consent and distribute the final care plan. Digital signatures must be tracked centrally, providing a clear audit trail for group practice compliance and ensuring the patient understands their cost-sharing responsibilities.

Best Practices
  • Use SMS-based consent links for faster patient turnaround
  • Store consent forms in a centralized repository accessible by all providers
Common Pitfalls
  • Proceeding with APCM billing without a documented patient signature
  • Failing to provide the patient with a copy of their finalized plan
6

Shared Resource Care Management Review

Implement a monthly review cycle using a shared pool of care managers across the group. This model allows the organization to scale APCM services efficiently without the need to hire dedicated care management staff for every single physician or site.

Best Practices
  • Set up a weekly 'huddle' for care managers to discuss complex cases
  • Rotate review responsibilities to maintain group-wide quality standards
Common Pitfalls
  • Siloing care managers to specific doctors, leading to uneven workloads
  • Neglecting to document the time spent on care management activities
7

Group-Wide Revenue and Attribution Tracking

Track APCM revenue and performance metrics via a centralized dashboard. This allows administrators to attribute revenue to the correct billing provider and monitor enrollment growth across the entire organization to identify underperforming sites.

Best Practices
  • Link revenue tracking to individual physician compensation models
  • Monitor enrollment-to-billing conversion rates weekly
Common Pitfalls
  • Pooling APCM revenue without clear physician-level attribution
  • Ignoring sites with low enrollment, which drags down group-wide MIPS scores

Expected Outcomes

1

Standardized clinical documentation across all group providers

2

Accurate revenue attribution for multi-physician billing cycles

3

Significant reduction in administrative burden via AI screening

4

Increased patient enrollment through automated outreach workflows

5

Enhanced compliance with Medicare APCM and MIPS reporting rules

Frequently Asked Questions

Medicare rules typically require attribution to the provider who provides the majority of primary care services. Our workflow uses historical billing data and encounter records to automate this attribution, ensuring the correct physician is credited for APCM billing.

Yes, AI-powered call centers can conduct standardized screenings for thousands of patients simultaneously. They record responses directly into the EHR, identify eligible chronic conditions, and flag interested patients for the clinical team, effectively replacing hundreds of manual hours.

We recommend implementing a group-wide APCM governance committee that approves standardized care plan templates. By using a centralized platform that integrates with the EHR, you can enforce these templates across all sites, ensuring clinical and regulatory consistency.

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APCM Care Plan Workflow for Group Practices | Tile Healthcare | Tile Health