Oncology APCM Compliance & Audit Readiness Checklist

Document that the patient has cancer plus at least one other chronic condition, such as hypertension or diabetes, qualifying them for APCM.

Maintain a signed consent form or a recorded verbal consent for APCM services, specifically mentioning AI-assisted monitoring and data sharing.

Ensure the patient had a face-to-face visit with the oncologist or NPP within the last 12 months before APCM billing commenced.

Document how the patient's cancer diagnosis or treatment regimen puts them at significant risk of functional decline or acute exacerbation.

Cross-reference APCM enrollment with the NCCN-compliant survivorship care plan to ensure alignment between monitoring and long-term goals.

Ensure that patients interacting with AI call handlers have been informed of the automated nature of the outreach as per HIPAA guidelines.

Record the time clinical staff spends reviewing automated AI alerts regarding chemotherapy side effects like nausea or neuropathy.

Track time spent communicating with radiation oncologists, surgeons, or palliative care teams regarding the patient's integrated care plan.

Log time spent on clinical trial eligibility screening or protocol adherence monitoring as part of the monthly care management time.

Document time spent coordinating oral oncolytics with specialty pharmacies or managing nutritional support for cachexia patients.

Verify that the practice provides a mechanism for 24/7 patient access to clinical staff or AI-triage systems for urgent symptom reporting.

Ensure every interaction, whether via AI call handler or nurse follow-up, is timestamped and attributed to the specific patient record.

Use Common Terminology Criteria for Adverse Events (CTCAE) in all APCM notes to provide objective data on side effect severity.

Specifically record monitoring for immune-related adverse events (irAEs) for patients on checkpoint inhibitors or CAR-T therapies.

Revise the care plan at least once per billing cycle to reflect changes in treatment response, staging, or palliative needs.

Document the ongoing assessment of cancer-related pain and the efficacy of prescribed analgesics or integrative therapies.

Ensure all hospital discharges or emergency department visits for oncology complications are documented within the APCM care log.

Confirm that the patient or their caregiver has been provided with a copy of the care plan in a digital or physical format.