APCM Audit Readiness for Infectious Disease Practices

Confirm patients have at least two chronic conditions or one complex infection like HIV/AIDS as per CMS IACCI guidance.

Ensure verbal or written consent for APCM services is recorded in the EHR, including a discussion of cost-sharing responsibilities.

Use clinical data to categorize HIV or Hepatitis B patients by risk level to prioritize outreach and resource allocation.

Complete a face-to-face or telehealth visit to establish the APCM relationship before initiating monthly billing.

Identify barriers to care such as transportation or housing instability that affect medication adherence in ID populations.

Include current ART regimen, viral load goals, and opportunistic infection prophylaxis in the electronic care plan.

Document scheduled labs for HBeAg, ALT levels, and HCC screening intervals within the patient record.

Perform and document reconciliation of all medications, specifically checking for drug-drug interactions with antivirals.

Use AI-driven call systems to confirm patients are taking medications as prescribed and identify reasons for non-adherence.

For post-infectious conditions, document ongoing symptoms and functional status changes over time to justify management.

Provide patients with a way to reach a clinical staff member at any time, often facilitated by AI-integrated call routing.

Implement automated outreach for ART or HBV antiviral refills to prevent treatment gaps and viral resistance.

Conduct outreach within 48-72 hours of hospital discharge for patients with severe acute-on-chronic infections.

Record all educational materials provided regarding infection transmission, side effects, and self-management.

Ensure all communications regarding sensitive diagnoses like HIV are handled through HIPAA-compliant platforms.

Accurately record minutes spent on care coordination, pharmacy calls, and AI-assisted patient outreach.

Maintain monthly snapshots of the care plan to prove it was updated and shared with the patient as required.

Ensure APCM billing does not duplicate services funded by the Ryan White HIV/AIDS Program to avoid double-dipping.

Cross-reference patient engagement logs with claims submitted to ensure all billed time is supported by documentation.

Keep logs of staff training on APCM codes and Infectious Disease-specific documentation requirements.