Workflow GuideNextGen Healthcare

NextGen APCM Patient Enrollment Workflow Guide

Optimize NextGen Healthcare workflows for APCM enrollment. Learn to identify, consent, and bill chronic care patients using AI automation.

Successfully launching Advanced Primary Care Management (APCM) within NextGen Healthcare requires a synchronized approach across the EHR and PM systems. This guide outlines how to leverage NextGen’s population health tools and AI-driven call handling to identify, educate, and enroll eligible patients into your chronic care program while ensuring compliance with CMS documentation standards.

The Challenge

Practices often struggle with manually identifying APCM-eligible patients in NextGen, leading to missed revenue and fragmented care. High call volumes for patient education and consent further strain front-desk staff, often resulting in low enrollment rates and incomplete documentation.

Step-by-Step Workflow

1

Identify Eligible Patients in NextGen PopHealth

Utilize NextGen Population Health tools to run a query against your patient database. Filter by ICD-10 codes associated with chronic conditions and risk scores to generate a list of candidates eligible for APCM G-codes.

Best Practices
  • Create a custom registry for APCM-specific codes in the reporting module.
  • Cross-reference with NextGen PM to ensure active insurance coverage.
Common Pitfalls
  • Relying on manual chart reviews which are prone to human error and time-consuming.
2

Deploy AI-Powered Patient Outreach

Integrate AI call handling to automate the initial outreach to the identified list. The AI explains the benefits of APCM, such as 24/7 access to care, and gauges patient interest without tying up your phone lines.

Best Practices
  • Script the AI to address common patient concerns regarding monthly copays.
  • Use AI to schedule follow-up calls for patients who need more time.
Common Pitfalls
  • Using generic robocalls that lack the conversational depth needed for patient education.
3

Capture and Document Patient Consent

Once a patient agrees to the program, document verbal or written consent directly in the NextGen EHR. Use a standardized APCM template to record the date, time, and specific provider who discussed the program.

Best Practices
  • Enable a 'Consent' checkbox within the Care Management section of the patient's chart.
  • Store signed digital consent forms in the NextGen Document Management System.
Common Pitfalls
  • Failing to document that the patient was informed about their right to stop the service at any time.
4

Establish the Comprehensive Care Plan

Use the NextGen Care Management module to build a patient-centered care plan. This must include a problem list, expected outcomes, and coordination with specialty providers, all accessible via the NextGen Patient Portal.

Best Practices
  • Pull data from the NextGen EHR 'History' and 'Assessment' sections to populate the plan.
  • Update the care plan during every clinical touchpoint to ensure accuracy.
Common Pitfalls
  • Creating a generic care plan that does not address the specific chronic needs of the patient.
5

Configure NextGen PM for APCM Billing

Update the Master File Maintenance in NextGen PM to include new APCM codes. Ensure that the billing logic is set to prevent duplicate billing with other care management services like CCM or RPM.

Best Practices
  • Set up automatic alerts in the PM system for missing modifiers.
  • Verify that the provider NPI is correctly mapped for the billing entity.
Common Pitfalls
  • Forgetting to update the practice's fee schedule with the latest CMS reimbursement rates.
6

Implement Time Tracking and Monthly Reporting

Train clinical staff to use the NextGen EHR timer or care coordination logs to track the required minutes per month. Use the Care Management dashboard to monitor which patients have reached billing thresholds.

Best Practices
  • Use the 'Start/Stop' timer feature within the EHR encounter for non-face-to-face time.
  • Review the APCM dashboard weekly to identify patients nearing the threshold.
Common Pitfalls
  • Wait until the end of the month to document time, leading to under-reporting.

Expected Outcomes

1

Increased APCM enrollment rates through efficient AI outreach

2

Reduction in administrative burden for NextGen clinical staff

3

Higher reimbursement accuracy within the NextGen PM system

4

Improved patient outcomes through structured care coordination

5

Full compliance with CMS APCM documentation requirements

Frequently Asked Questions

NextGen Population Health tools use clinical data, ICD-10 codes, and risk stratification to flag patients meeting CMS criteria for Advanced Primary Care Management.

AI can facilitate the educational conversation and capture intent, but CMS requires that the final consent be documented in the EHR by clinical staff or through a verified digital signature.

To fully automate APCM, practices should utilize NextGen EHR, NextGen PM, and the Care Management module, ideally supplemented by Population Health for patient identification.

NextGen PM can be configured with 'Charge Edit' rules that flag or block APCM codes if a CCM or RPM code has already been billed for the same patient in the same calendar month.

Ready to transform your nextgen healthcare practice?

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

Schedule a Demo
NextGen APCM Patient Enrollment Workflow Guide | Tile Health