Workflow GuideMEDITECH

APCM Patient Enrollment Workflow for MEDITECH | Tile Healthcare

Master APCM patient enrollment in MEDITECH Expanse. Streamline chronic care management workflows and billing for community hospitals with AI automation.

Enrolling patients in Ambulatory Patient Care Management (APCM) within a MEDITECH environment requires precise coordination between the ambulatory module and hospital-based billing systems. For community and critical access hospitals, capturing eligible chronic care patients during the initial encounter is vital for sustainable revenue and improved population health outcomes.

The Challenge

Many MEDITECH practices struggle with manual enrollment gaps where eligible patients are missed due to fragmented workflows between Expanse ambulatory modules and legacy 6.x or Magic billing systems, leading to lost APCM revenue and inconsistent chronic care tracking.

Step-by-Step Workflow

1

Identify Eligible Patients via Population Health

Utilize MEDITECH Expanse's Population Health or Business and Clinical Analytics (BCA) to generate registry lists of patients with two or more chronic conditions eligible for APCM.

Best Practices
  • Use BCA for automated weekly reporting.
Common Pitfalls
  • Relying on manual chart reviews which miss up to 40% of eligible patients.
2

Verify Insurance and APCM Eligibility

Cross-reference patient records with CMS requirements and specific payer rules within the MEDITECH registration or insurance verification screens to ensure no duplication of services.

Best Practices
  • Check for overlapping CCM or PCM codes from outside providers.
Common Pitfalls
  • Ignoring payer-specific exclusions for critical access hospitals.
3

Conduct Enrollment Call via AI Automation

Deploy Tile Healthcare's AI call handling to reach out to eligible patients, explain the benefits of the APCM program, and obtain initial verbal consent for enrollment.

Best Practices
  • Schedule AI calls during evening hours for better reach.
Common Pitfalls
  • Using clinical staff for cold calls instead of automated outreach.
4

Document Consent in MEDITECH Expanse

Record the patient's verbal or written consent directly in the Ambulatory module using a standardized APCM Enrollment template to ensure the data is discrete and reportable.

Best Practices
  • Use discrete data fields for easier BCA reporting later.
Common Pitfalls
  • Storing consent in scanned PDF notes only, making it unsearchable.
5

Establish the Comprehensive Care Plan

Create or update the patient's care plan in the MEDITECH EHR, ensuring it is accessible to all members of the care team and mapped to the patient's chronic diagnoses.

Best Practices
  • Involve the patient in goal setting via the portal.
Common Pitfalls
  • Using a generic care plan template that doesn't meet CMS requirements.
6

Configure Billing and APCM Codes

Set up the appropriate billing triggers in the MEDITECH Revenue Cycle or BAR module to ensure APCM codes are captured separately from hospital-based technical fees.

Best Practices
  • Verify the Pro-Fee vs Technical-Fee split for outpatient services.
Common Pitfalls
  • Bundling APCM with inpatient charges by mistake.

Expected Outcomes

1

Increased APCM enrollment rates through automated patient outreach.

2

Accurate documentation of patient consent within the MEDITECH Expanse EHR.

3

Streamlined billing processes that separate professional fees from hospital charges.

4

Improved management of chronic conditions for rural and community populations.

Frequently Asked Questions

Consent is typically documented using a specific 'APCM Consent' form in the Ambulatory module, which can be flagged for reporting in BCA.

Yes, AI solutions can interface with MEDITECH's scheduling API to trigger enrollment calls based on upcoming appointments or diagnosis codes.

Enrollment workflows often require manual entry into a tracking spreadsheet or a custom-built screen until data can be ported to a more modern reporting tool.

Ready to transform your meditech practice?

See how Tile Healthcare's AI call center can handle scheduling, triage, and patient communication for your practice.

Schedule a Demo
APCM Patient Enrollment Workflow for MEDITECH | Tile Healthcare | Tile Health