Athenahealth APCM Implementation & Billing Checklist

Enable and customize the care management module in athenaOne to track APCM-specific encounters and non-face-to-face time.

Establish specific workgroups within athenaOne to route APCM-related tasks and patient communications efficiently.

Add and map new APCM HCPCS codes to your local fee schedule and ensure they are linked to the correct departments.

Update encounter templates to include required APCM documentation elements like social determinants of health (SDOH) assessments.

Configure athenaCommunicator to deliver APCM enrollment notifications and educational materials to eligible patients.

Create reports to identify patients with two or more chronic conditions who meet the APCM enrollment criteria.

Utilize the athenahealth chronic disease registry to cross-reference eligible patients with recent office visits.

Develop a tracking mechanism in athenaOne to monitor which patients have consented to APCM services.

Regularly run reports on staff time logged in the care management module to ensure billing thresholds are met.

Identify patients missing the required annual SDOH assessment using athena's built-in quality management reports.

Work with your athenahealth CSM to implement custom claim edit rules that prevent billing APCM codes with conflicting CCM codes.

Confirm that your top payers recognize G0556, G0557, and G0558 codes within the athena billing system.

Set up automated billing triggers in athenaOne once the monthly care management requirements are documented.

Monitor the athenahealth 'Claim at Check' and denial work queues specifically for APCM code rejections.

Use the athenahealth financial dashboard to track the ROI of your APCM program and ensure accurate reimbursement.

Connect Tile Healthcare or similar AI tools to your athenahealth phone lines to manage high volumes of APCM inquiries.

Use AI voice agents to contact eligible patients identified in your athena reports to explain APCM benefits.

Ensure all AI-driven patient interactions are automatically documented as notes or tasks within the patient chart.

Leverage AI call centers to meet the CMS requirement for 24/7 patient access to care teams without increasing staff.

Enable AI agents to schedule required follow-up visits directly into the athenaOne calendar based on APCM protocols.