Workflow GuideNextGen Healthcare

NextGen APCM Care Plan Workflow & Integration Guide

Master APCM care plan creation in NextGen Healthcare. Learn to automate workflows, track time, and optimize billing for chronic care management.

This guide outlines the essential workflow for creating and managing APCM care plans within NextGen Healthcare. By integrating NextGen’s robust Care Management module with AI-powered automation, practices can efficiently identify high-risk patients, document comprehensive care plans, and ensure all CMS compliance requirements are met for optimal reimbursement.

The Challenge

NextGen practices often face bottlenecks when manually tracking care management minutes and updating care plans. Without a structured digital workflow, clinical teams struggle to maintain the documentation required for APCM billing, leading to lost revenue and fragmented patient care.

Step-by-Step Workflow

1

Patient Identification via NextGen Population Health

Use the Population Health tool to filter your patient panel by chronic condition codes and risk scores. This automated identification ensures that no APCM-eligible patient is overlooked during the enrollment phase by pulling real-time data from the NextGen database.

Best Practices
  • Use the HCC risk score filter to prioritize high-need patients
  • Automate weekly report exports to the care team
Common Pitfalls
  • Manual chart scrubbing which wastes clinical hours
  • Missing dual-eligible patients due to outdated insurance filters
2

Care Plan Template Customization in NextGen EHR

Access the Care Management module to build a standardized APCM template. Ensure the template includes problem lists, expected outcomes, and medication reconciliation fields that pull directly from the patient's existing chart data to minimize manual entry.

Best Practices
  • Map fields to KBM templates for data continuity
  • Include a dedicated Patient Goals section for CMS compliance
Common Pitfalls
  • Using static PDF care plans that don't sync with the EHR
  • Duplicate data entry across multiple clinical tabs
3

AI-Driven Outreach and Enrollment Documentation

Deploy AI call handling to contact eligible patients for APCM enrollment. The AI explains program benefits, obtains verbal consent, and pushes the interaction logs directly into the NextGen encounter notes, ensuring a complete audit trail without manual provider intervention.

Best Practices
  • Log consent in the Legal tab of the patient chart
  • Use AI for automated monthly check-in calls
Common Pitfalls
  • Relying on clinical staff for outbound enrollment calls
  • Incomplete documentation of patient consent for the APCM program
4

Real-Time Time Tracking in the Care Management Dashboard

Utilize the Time Tracking feature within NextGen to record every minute spent on care coordination. This includes phone calls, specialist referrals, and medication management performed outside of face-to-face visits, satisfying APCM's time-based billing requirements.

Best Practices
  • Enable the stopwatch feature for accurate minute logging
  • Train staff on non-visit coding for non-clinical tasks
Common Pitfalls
  • Rounding time down significantly and losing billable minutes
  • Forgetting to log specialist and pharmacy coordination time
5

Automated Billing Generation in NextGen PM

At the end of the calendar month, use the Care Management Billing report to identify patients who have met the APCM time requirements. Push these records to NextGen PM for claim generation with the appropriate G-codes and modifiers for APCM reimbursement.

Best Practices
  • Audit claims for G-code accuracy before final submission
  • Check for overlapping CCM and APCM codes to avoid denials
Common Pitfalls
  • Billing for the same patient twice in a single month
  • Ignoring rejected claims in the clearinghouse due to modifier errors

Expected Outcomes

1

100% compliance with CMS APCM documentation standards

2

25% increase in care management revenue via automated identification

3

Reduced administrative burden on nursing staff through AI outreach

4

Improved patient engagement scores via consistent monthly follow-ups

5

Seamless integration between NextGen EHR and PM for billing accuracy

Frequently Asked Questions

While NextGen provides time-tracking fields, our AI integration automates the logging of call durations and coordination tasks directly into the Care Management module to ensure no minutes are missed.

APCM requires specific G-codes and often higher-level coordination; NextGen PM must be configured with specific fee schedules and modifiers to distinguish these from traditional CCM services.

Yes, NextGen Mobile allows providers to review and sign off on care plan updates remotely, ensuring the clinical staff oversight requirement is met even when providers are away from their workstations.

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NextGen APCM Care Plan Workflow & Integration Guide | Tile Health