APCM Implementation for Pain Management Clinics

Scan the EHR for patients with 2+ chronic conditions such as fibromyalgia and clinical depression or spinal stenosis.

Ensure every APCM candidate has a signed, current opioid contract on file before initiating monthly care coordination.

Secure and log verbal or written patient consent for APCM billing, explaining the monthly copay and service benefits.

Use the Opioid Risk Tool (ORT) or similar assessment to categorize patients by risk level for monitoring frequency.

Record baseline scores using the PEG scale or Pain Disability Index to track APCM efficacy over time.

Confirm coverage for G0511 or specialty-specific APCM codes for each enrolled chronic pain patient.

Configure AI tools to flag if a PDMP check hasn't been performed prior to the monthly APCM care coordination call.

Develop templates that include non-pharmacologic treatments and interventional procedure follow-ups for documentation.

Ensure the system captures every minute of staff time spent on care coordination to meet the 20-minute billing threshold.

Verify all adjuvant medications, such as gabapentinoids or NSAIDs, are reconciled monthly during the APCM call.

Cross-reference APCM check-ins with Urine Drug Screen schedules to ensure high-risk patients remain compliant.

Periodically review APCM notes to ensure they provide sufficient evidence for medical necessity in opioid prescribing.

Set up AI agents to call patients monthly to collect pain scores and assess medication efficacy and side effects.

Program the AI system to immediately notify a clinical nurse if a patient reports a pain level spike above their baseline.

Use AI screening to ask specifically about opioid-induced constipation, sedation, or respiratory issues.

Schedule AI calls to check on patients 24-48 hours after interventional procedures like epidurals or RFAs.

Ensure AI call summaries and patient responses are automatically pushed into the EHR for provider review.

Implement an AI-driven line for after-hours calls to provide triage instructions for non-emergency pain flares.

Use monthly APCM calls to verify patient attendance at physical therapy and update the care plan accordingly.

Monitor patients with spinal cord stimulators or intrathecal pumps for battery status and site integrity.

Coordinate with psychologists or counselors for patients requiring CBT as part of their multimodal pain plan.

Document the use of TENS units, bracing, or topical agents during each monthly care coordination cycle.

Document communication with the patient's primary care physician regarding the overall pain management strategy.

Push educational content via AI-driven SMS or email regarding anti-inflammatory diets or gentle movement.