APCM Revenue Calculator for eClinicalWorks Practices
Calculate your practice's potential revenue from CMS APCM codes using eClinicalWorks and AI-powered patient outreach automation.
Unlock the financial potential of Advanced Primary Care Management (APCM) within your eClinicalWorks ecosystem. This calculator estimates your monthly and annual revenue by leveraging eCW population health data and Tile Health's AI-driven patient engagement to automate the outreach and documentation required for high-volume APCM billing.
Your Numbers
The total number of active patients in your eClinicalWorks database.
Percentage of patients with 2 or more chronic conditions (found in eCW Registry).
Percentage of eligible patients successfully enrolled via Tile Health AI outreach.
The blended monthly reimbursement rate per patient for APCM codes (e.g., G0511 or Level 1/2).
Projected monthly gross revenue based on successful eCW patient enrollment.
Estimated yearly revenue from a fully optimized APCM program in eClinicalWorks.
How this calculator works
The calculation identifies your eligible patient base from the eCW registry (those with 2+ chronic conditions), applies a realistic enrollment rate achieved through AI outreach, and multiplies this by current CMS reimbursement rates for APCM G-codes. This provides a gross revenue estimate before operational expenses.
Assumptions- Assumes all enrolled patients meet CMS eligibility criteria for 2+ chronic conditions.
- Calculations based on 2026 Medicare APCM national average reimbursement rates.
- Assumes eClinicalWorks billing module is configured to support APCM G-codes.
- Enrollment rates assume the use of Tile Health AI for automated patient outreach and consent.
- Does not account for regional wage index adjustments or specific payer variations.
Frequently Asked Questions
Use the eCW Registry or Population Health (HEDIS) dashboards to filter patients by ICD-10 codes associated with chronic conditions. Tile Health can integrate with these lists to initiate AI-led outreach.
While eClinicalWorks has a Care Management module, many practices find it manually intensive. Tile Health automates the patient calls and documentation that the native module requires staff to perform.
Practices typically use G0511 for RHCs/FQHCs or specific primary care APCM codes (Level 1, 2, or 3) depending on the complexity and patient needs documented in the eCW encounter.
AI automates the 20+ minutes of non-face-to-face care management required each month, ensuring you meet billing requirements without increasing staff overhead in eClinicalWorks.
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