Endocrinology APCM Compliance & Audit Readiness Checklist

Verify the diagnosis of two or more chronic conditions, such as Type 2 Diabetes and Hypertension, expected to last at least 12 months.

Obtain and document verbal or written patient consent for APCM services in the EHR, including an explanation of cost-sharing responsibilities.

Verify patient has not been hospitalized within the last 30 days without a transition of care note to prevent billing overlaps.

Validate that the patient is not currently enrolled in a competing CCM or RPM program through another provider or primary care office.

Assess social determinants of health (SDOH) that impact diabetes management, such as food insecurity or transportation barriers for lab visits.

Conduct monthly outreach to track A1C levels and schedule necessary lab work for thyroid or metabolic panels to ensure timely medication titration.

Document all insulin dosage adjustments made based on patient-reported glucose logs or continuous glucose monitor (CGM) data streams.

Utilize AI-powered phone systems to automate routine follow-ups for medication refills and diet compliance, capturing data for clinical review.

Screen for symptoms of hypoglycemia or hyperglycemia during every monthly touchpoint to prevent emergency room visits and hospitalizations.

Monitor patient adherence to Levothyroxine or other hormone replacement therapies and document any barriers to medication compliance.

Maintain a time-stamped log of all clinical staff interactions, ensuring a minimum of 20 minutes of non-face-to-face care per month.

Ensure the comprehensive care plan is updated at least annually or upon any significant change in the patient's metabolic status.

Store automated call transcripts and patient responses as part of the permanent medical record to provide proof of outreach during audits.

Reconcile medication lists during each monthly interaction, specifically focusing on complex GLP-1, SGLT2, and insulin regimens.

Perform quarterly internal audits of APCM billing codes to ensure they align exactly with the documented clinical time and staff credentials.