APCM Compliance & Audit Readiness Checklist | Tile Healthcare

Verify that patients have round-the-clock access to clinical staff for urgent needs via AI-integrated phone systems.

Ensure patients see a designated practitioner or member of the care team for successive routine appointments.

Document systematic assessment of health needs, including medical, functional, and psychosocial requirements.

Identify high-risk patients and provide enhanced care management services tailored to their specific chronic conditions.

Document follow-up with patients after discharge from hospitals or SNFs within CMS-mandated timelines.

Maintain logs of communication with community-based service providers to ensure holistic patient support.

Confirm a comprehensive care plan is established, recorded in the EHR, and shared electronically with the patient.

Use AI call logging to capture every minute of patient interaction to meet the time-based or service-based requirements.

Store verifiable proof of patient consent for APCM services, including notification of cost-sharing responsibilities.

Schedule periodic reviews of the care plan, updating it to reflect changes in the patient's health status or goals.

Document evidence that care goals were developed in collaboration with the patient and their caregivers.

Perform and document medication reconciliation for every patient enrolled in the APCM program regularly.

Establish a digital archive for all APCM-related documentation to comply with CMS and OIG retention policies.

Conduct quarterly mock audits of patient charts to identify gaps in the 13 service elements before CMS does.

Review automated transcripts and call logs from AI systems to ensure clinical relevance and accuracy for auditors.

Provide biannual training on APCM billing codes and documentation requirements to prevent institutional knowledge loss.

Analyze billing patterns to identify potential over-coding or under-documentation that could trigger an audit.

Monitor HEDIS and other quality metrics linked to APCM to demonstrate program efficacy to payers.