Workflow GuideOB/GYN & Women's Health

APCM Enrollment Workflow for OB/GYN & Women's Health

Optimize OB/GYN revenue with our APCM enrollment guide for postmenopausal care, HRT monitoring, and chronic pelvic pain management for Medicare patients.

Transitioning postmenopausal patients into Advanced Primary Care Management (APCM) allows OB/GYN practices to provide continuous, high-touch monitoring for chronic conditions like osteoporosis and HRT risks while capturing neglected Medicare revenue streams through automated care coordination.

The Challenge

Many OB/GYN practices lose significant revenue because they view Medicare-age women only for annual exams, failing to document the chronic management required for HRT, pelvic floor disorders, and cancer survivorship under APCM guidelines.

Step-by-Step Workflow

1

Identify Eligible Medicare Panel

Utilize AI-driven EHR scanning to identify Medicare patients with two or more chronic conditions such as osteoporosis, cardiovascular risk factors, chronic pelvic pain, or gynecologic cancer survivorship requirements.

Best Practices
  • Focus on patients currently on long-term HRT
  • Include patients with documented pelvic floor dysfunction
Common Pitfalls
  • Excluding patients whose primary care is managed elsewhere
  • Missing patients with sub-clinical bone density loss
2

Automated AI Patient Outreach

Deploy AI call agents to contact eligible patients, explaining the benefits of the APCM program including 24/7 access to care and proactive hormone management, while securing required verbal or digital consent.

Best Practices
  • Script the AI to emphasize HRT safety monitoring
  • Highlight the convenience of remote care coordination
Common Pitfalls
  • Using overly technical medical jargon during outreach
  • Failing to document the date and time of patient consent
3

Initial Chronic Care Assessment

Conduct a comprehensive initial assessment focusing on gynecologic-specific chronic needs, including fall risk for osteoporosis patients and cardiovascular screening for those on estrogen therapy.

Best Practices
  • Use standardized ACOG menopause assessment tools
  • Review all medications for potential HRT interactions
Common Pitfalls
  • Neglecting to update the problem list in the EHR
  • Forgetting to establish specific patient-centered goals
4

Establish 24/7 Access Protocols

Configure the AI call center to provide 24/7 access for APCM-enrolled patients, ensuring urgent gynecologic concerns like postmenopausal bleeding or HRT side effects are triaged immediately to clinical staff.

Best Practices
  • Set clear escalation paths for acute pelvic pain
  • Ensure the AI has access to the patient's current care plan
Common Pitfalls
  • Relying on generic after-hours voicemails
  • Failing to log after-hours interactions in the APCM time-tracker
5

Monthly Care Management Documentation

Track at least 20 minutes of non-face-to-face care coordination per month, including AI-driven check-ins on medication adherence, bone density follow-ups, and coordination with specialists like oncologists or urogynecologists.

Best Practices
  • Automate the logging of every patient interaction
  • Include time spent reviewing lab results and imaging
Common Pitfalls
  • Under-reporting time spent on care coordination
  • Inconsistent monthly follow-ups leading to billing gaps
6

Final Compliance and Billing Review

Perform a monthly audit of APCM logs to ensure all CMS requirements are met before submitting claims for G0511 or other relevant APCM codes, focusing on the management of chronic gynecologic conditions.

Best Practices
  • Verify the care plan was shared with the patient
  • Ensure the EHR reflects the management of two chronic conditions
Common Pitfalls
  • Billing for patients who also have CCM billed by a PCP
  • Lack of evidence for 24/7 access in the audit trail

Expected Outcomes

1

Increased recurring revenue from the Medicare GYN patient panel

2

Improved adherence to HRT monitoring and osteoporosis treatment

3

Enhanced patient satisfaction through 24/7 AI-supported access

4

Reduced emergency room visits for chronic pelvic or hormonal issues

5

Streamlined documentation for CMS APCM compliance audits

Frequently Asked Questions

Yes, as long as the specialist is managing at least two chronic conditions and the patient has not enrolled in a similar program (like CCM) with another provider during the same billing period.

The most common qualifying conditions include osteoporosis, chronic pelvic pain, symptomatic menopause requiring HRT, pelvic organ prolapse, and long-term gynecologic cancer survivorship care.

AI automates the labor-intensive process of identifying eligible patients, explaining the program benefits, and capturing consent, which typically overwhelms manual front-desk staff.

While not strictly required, using a template that specifically tracks 'non-face-to-face' time and maps to ACOG guidelines for chronic care is highly recommended for audit protection.

Ready to transform your ob/gyn & women's health practice?

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

Schedule a Demo
APCM Enrollment Workflow for OB/GYN & Women's Health | Tile Health