APCM Compliance & Audit Checklist for Athenahealth

Use athenaOne Report Builder to filter patients by chronic condition counts and active status to identify candidates for G0556, G0557, or G0558.

Enable the Care Management module in athenaOne to track enrollment dates and consent status for every APCM-enrolled patient.

Ensure G0556, G0557, and G0558 are active in your local athena billing library with correct fee schedules and diagnosis requirements.

Utilize athena's automated eligibility verification to confirm patient insurance supports APCM billing before initiating services.

Create custom fields or global alerts in athenaOne to visually flag patients who have signed the APCM participation agreement.

All care coordination time must be documented in the athenaOne encounter or case with specific start and stop times or total durations.

Maintain evidence of patient access to clinicians after hours, utilizing athena's after-hours call routing or integrated AI phone logs.

Ensure all outreach and coordination efforts are directly tied to the patient's active Care Plan within the athenaOne Chart.

Use athena's native SDOH screening tools to document barriers to care, a key requirement for higher-level APCM code selection.

Create athenaOne text macros or templates to ensure all required APCM elements are documented consistently by the clinical team.

Work with your athena CSM to set up custom billing rules that prevent APCM codes from being billed with conflicting CCM or PCM codes.

Regularly review athena's claim manager for APCM codes held due to missing documentation or mismatched chronic condition diagnosis codes.

Perform monthly internal audits comparing athenaOne time logs against claims submitted to ensure billing accuracy for G0557 and G0558.

Ensure APCM claims are submitted with the correct POS (typically 11) to avoid automated athena billing engine rejections.

Import call logs from your AI phone system into athenaOne to justify time spent on patient engagement and care coordination.