APCM Compliance & Audit Readiness Checklist | Tile Healthcare
Ensure your practice meets all 13 CMS APCM service elements. Use our audit readiness checklist to prevent clawbacks and streamline care plan documentation.
Navigating the 13 required service elements for Advanced Primary Care Management (APCM) is critical to avoiding CMS clawbacks and penalties. This checklist provides a structured framework for compliance officers and practice managers to ensure every enrolled patient receives compliant care. By leveraging AI-powered call handling, practices can automate the documentation of patient interactions,...
Work through each item below to audit your practice. Check off completed items to track where you stand.
The 13 CMS Service Elements Verification
Verification of the core requirements mandated by CMS for APCM reimbursement and program integrity.
Documentation & Care Planning Standards
Focus on the creation, maintenance, and distribution of patient-centered care plans as required by Medicare.
Audit Preparation & Quality Assurance
Protocols to ensure the practice is ready for a CMS or OIG audit at any time without risk of penalties.
Frequently Asked Questions
The 13 elements include 24/7 access to care, continuity of care, comprehensive care management, care planning, transitional care management, and coordination with community providers, among others required by CMS.
AI call centers automatically document every patient interaction, creating time-stamped, searchable records and transcripts that prove service delivery for each of the 13 elements, ensuring a complete audit trail.
Most clawbacks result from a lack of documentation showing that all 13 service elements were available or provided to the patient during the specific billing period.
In accordance with CMS and False Claims Act guidelines, it is recommended to retain all APCM-related documentation and care plans for at least seven years.
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