NextGen APCM Compliance & Audit Readiness Checklist

Update NextGen EHR templates to include specific fields for APCM care plan updates and clinical intervention tracking.

Verify that APCM G-codes are correctly mapped within NextGen File Maintenance to prevent billing rejections at the clearinghouse.

Use NextGen clinical alerts to notify providers when APCM care plans are due for the mandatory 90-day clinical review.

Configure NextGen Mobile to allow care managers to document APCM-eligible interactions and time spent while away from their desks.

Audit the Problems list in NextGen to ensure patients meet the two or more chronic condition criteria required for APCM enrollment.

Set up specific modifiers in NextGen PM to differentiate APCM services from standard E/M or traditional CCM billing codes.

Use NextGen's document management to store signed APCM consent forms, ensuring they are digitally linked to the patient's billing record.

Utilize NextGen's reporting tools to aggregate time spent by care managers and AI agents on APCM-eligible activities.

Configure NextGen Claim Check to identify and flag potential duplicate billing between APCM and other care management codes.

Use NextGen Report Writer to track APCM payment rates and identify any persistent payer denials or underpayments.

Utilize NextGen Population Health to identify patients with high-risk HCC scores who are eligible for APCM enrollment.

Use AI-powered call handling to contact eligible patients, explain APCM benefits, and sync enrollment status back to NextGen.

Ensure AI call center summaries and timestamps are automatically pushed into NextGen EHR encounter notes for audit trails.

Regularly review NextGen eligibility reports to ensure patients still meet the clinical criteria for ongoing APCM billing cycles.

Filter NextGen data by HCC risk scores to prioritize APCM outreach for the most complex and high-utilization patient populations.