APCM Compliance Checklist for Heart Failure Management

Ensure the patient record contains specific heart failure diagnosis codes required for G0557 or G0558 reimbursement levels.

Obtain and electronically time-stamp patient consent for APCM services, explaining the cost-sharing and 24/7 access benefits.

Verify active Medicare Part B enrollment to ensure the practice can bill for APCM without claim rejection.

Identify and document the 4-6 average comorbidities found in HF patients to justify higher-level APCM billing codes.

Establish a comprehensive heart failure care plan that includes fluid goals, weight targets, and medication titration protocols.

Use AI call systems to collect daily weights and automatically flag increases of 3lbs in 24 hours or 5lbs in a week.

Document patient-reported fluid intake during weekly automated check-ins to ensure adherence to restriction goals.

Maintain a detailed log of all phone-based clinical decisions regarding diuretic dose adjustments based on weight fluctuations.

Perform and document quarterly assessments of New York Heart Association functional classification to track disease progression.

Integrate and document reviews from ICD or CRT-D remote monitoring systems into the monthly APCM clinical record.

Document a clinical phone call within 48 hours of any hospital discharge to review symptoms and medication changes.

Compare pre-hospitalization heart failure meds with post-discharge scripts, specifically focusing on GDMT changes.

Ensure all eligible HFrEF patients have a documented referral to cardiac rehabilitation or a reason for exclusion.

For Stage D patients, document discussions regarding palliative care or advanced directive updates during care coordination.

Provide documentation that heart failure patients have a clear pathway to reach a clinician at any time for urgent symptoms.

Regularly review AI-generated transcripts of patient calls to ensure clinical accuracy and appropriate symptom escalation.

Verify that all automated weight and symptom data is transmitted via encrypted channels into the EHR.

Document the logic used by AI to route high-risk heart failure patients to a live nurse or cardiologist immediately.

Generate monthly reports showing patient response rates to automated check-ins to demonstrate active APCM management.

Store all automated interaction records as part of the legal medical record to support APCM time-based billing.