APCM Transition Checklist: CCM to Advanced Primary Care Management

Determine which patients fall into APCM Level 1, 2, or 3 based on hierarchical condition categories.

Run a side-by-side comparison of 99490/99491 monthly revenue against projected APCM tiered payments.

Review patients currently requiring 60+ minutes of CCM to see if APCM Level 3 covers the resource intensity.

Estimate the administrative cost reduction from eliminating minute-by-minute time logging requirements.

Identify patients receiving services that cannot be billed alongside APCM, such as Principal Care Management.

Modify templates to focus on service elements like 24/7 access and risk management rather than time logs.

Deploy AI voice agents to manage after-hours calls, ensuring the APCM 24/7 access requirement is met and documented.

Standardize the process for the required initiating visit for new APCM patients not seen within 12 months.

Set up automated triggers for follow-up calls after hospital discharge to meet APCM care coordination standards.

Update the billing calendar to trigger APCM codes once service elements are met, regardless of time spent.

Ensure the team understands that APCM and CCM cannot be billed for the same patient in the same month.

Shift focus from 'hitting 20 minutes' to providing comprehensive management based on patient risk levels.

Use automated phone systems to contact existing CCM patients and obtain documented consent for the APCM transition.

Revise handouts to explain how APCM focuses on overall care quality and 24/7 access rather than monthly check-ins.

Create a monthly review process to decide which patients should remain on CCM vs. transitioning to APCM.