Urology APCM Compliance & Audit Readiness Checklist

Confirm patients have 2+ chronic conditions such as BPH, OAB, or chronic kidney stones expected to last 12+ months.

Ensure the patient has active coverage that supports APCM/CCM billing codes to prevent claim denials.

Obtain and record verbal or written consent in the EHR, explaining cost-sharing and the right to stop the service.

Distribute urology-specific brochures explaining how chronic monitoring improves outcomes for conditions like prostate cancer.

Identify patients transitioning from acute surgical care to long-term surveillance for APCM enrollment opportunities.

Document initial and serial AUA Symptom Scores (IPSS) for all BPH patients to track treatment efficacy.

Maintain a structured log of PSA results and biopsy intervals for patients on active surveillance for prostate cancer.

Ensure 24-hour urine collection results and hydration counseling are documented for chronic stone formers.

Review and document adherence to anticholinergics or beta-3 agonists and any reported side effects.

Explicitly document how the patient can access the care team after hours, including AI-triage or on-call services.

Record specific advice given regarding bladder irritants, fluid management, and pelvic floor exercises.

Use AI call handling to automatically log minutes spent on patient inquiries regarding catheters or UTI symptoms.

Ensure AI-generated summaries of patient phone interactions are exported directly to the patient's clinical record.

Document time spent by staff coordinating with imaging centers or nephrologists for complex urology cases.

Utilize a dashboard to track which patients have met the minimum monthly time requirement for billing.

Have a clinician briefly review AI summaries for accuracy before finalizing the month's APCM documentation.

Review a random sample of APCM claims to ensure documentation supports the billed time and complexity.

Ensure care plans are shared electronically with other providers involved in the patient's urologic care.

Keep a chronological log of all patient-initiated communications, including those handled by AI automation.

Ensure APCM is not billed during a 10 or 90-day surgical global period unless for an unrelated condition.

Verify that every APCM patient has an updated comprehensive care plan at least once every 12 months.