Solo Practice APCM Implementation Checklist | Tile Healthcare

Confirm that your solo practice is correctly enrolled as the primary billing entity for Medicare Part B services.

Run EHR reports to identify patients with two or more chronic conditions expected to last at least 12 months.

Secure and document verbal or written consent for APCM services, including notification of potential cost-sharing.

Implement an AI-powered call solution to meet the Medicare requirement for 24/7 patient access to care management.

Ensure your outsourced AI or virtual staff arrangement complies with CMS incident-to supervision requirements for solo doctors.

Connect your AI care management platform to your EHR to ensure seamless updates of patient interactions and care plans.

Set specific triggers for when the AI system must escalate a patient call directly to the physician for urgent clinical review.

Schedule the AI to perform the required monthly check-ins for the 20-minute care management threshold.

Set up AI workflows to handle routine medication list verifications during monthly care management calls.

Develop digital care plan templates within the AI system that populate automatically based on patient responses.

Utilize software that automatically logs every minute of care coordination provided by the AI and physician.

Ensure your billing software is updated with the latest APCM-specific codes for solo practice reimbursement.

Review monthly reports to ensure no overlap between APCM and CCM/PCM codes to avoid claim denials.

Track the ratio of administrative costs versus APCM revenue to ensure the program remains a high-margin asset.

Establish a simple process for your biller to address rejected APCM claims specifically for the solo provider NPI.

Send digital or physical notices to eligible patients explaining how the new 24/7 care program benefits them.

Add a section to your solo practice website highlighting your advanced, AI-enabled chronic care management capabilities.

Input common solo practice questions into the AI logic to ensure patients receive personalized, accurate answers.

Use automated surveys to ensure patients find the AI check-ins valuable and are satisfied with the care coordination.

Create a consistent script for the AI to use when first introducing the care management program to a new patient.