Orthopedic APCM Implementation Checklist | Tile Healthcare

Identify patients with 2+ chronic conditions like osteoarthritis and comorbid hypertension or spinal stenosis.

Flag patients who have completed the 90-day global period but require ongoing mobility and pain monitoring.

Review DEXA scan history and frailty scores to enroll patients in a fall prevention and bone health program.

Ensure patients understand the APCM service, cost-sharing responsibilities, and 24/7 access to care.

Use specific codes to track enrolled patients and prevent duplicate billing across different orthopedic sub-specialties.

Deploy AI voice agents to handle after-hours patient inquiries regarding post-op pain or medication refills.

Create standardized plans for osteoarthritis management including PT compliance and weight management goals.

Use AI to reach out to patients for pain scale updates and home exercise program (HEP) adherence tracking.

Establish a digital feedback loop to ensure PT progress is documented within the 20-minute monthly APCM requirement.

Integrate standardized gait and balance questions into the monthly AI-driven patient interactions.

Use automated logs from AI interactions and staff coordination to meet Medicare time-based requirements.

Ensure care plans reflect current AAOS clinical practice guidelines for musculoskeletal health.

Ensure APCM billing does not conflict with active 90-day surgical global periods or bundled payment episodes.

Utilize correct HCPCS codes for Advanced Primary Care Management based on patient complexity and time spent.

Analyze APCM reimbursement rates against administrative costs to optimize practice profitability.