FQHC APCM Revenue Calculator | Tile Healthcare
Calculate potential 2026 APCM revenue for FQHCs. See how AI-powered patient outreach increases chronic care management enrollment and HRSA UDS compliance.
Calculate how Medicare’s Advanced Primary Care Management (APCM) codes can transform your FQHC’s financial health. By leveraging AI-powered call handling for chronic care outreach and SDOH screening, health centers can maximize per-patient-per-month (PPPM) revenue while meeting HRSA quality reporting requirements and improving patient outcomes in underserved communities.
Your Numbers
The total number of unique patients served by your FQHC annually.
Percentage of your patient population with 2 or more chronic conditions (typically 60-75% for FQHCs).
Expected percentage of eligible patients successfully enrolled through automated multilingual AI outreach.
Estimated 2026 PPS-adjusted monthly APCM reimbursement per patient.
Projected monthly recurring revenue from APCM billings.
The estimated total annual revenue increase for your FQHC through AI-managed APCM.
How this calculator works
This calculator estimates your annual revenue by applying your specific patient volume and chronic disease prevalence against projected 2026 FQHC PPS-adjusted APCM reimbursement rates. It factors in the efficiency of AI-driven multilingual outreach to determine your expected enrollment and recurring revenue without increasing administrative burden on clinic staff.
Assumptions- Calculations are based on projected 2026 Medicare APCM reimbursement rates for FQHCs.
- Enrollment efficiency assumes the use of multilingual AI call automation for consistent patient outreach and consent.
- All enrolled patients meet the G0511 or APCM-specific criteria for two or more chronic conditions.
- Revenue estimates do not account for FQHC-specific sliding fee scale adjustments for uninsured patients.
Frequently Asked Questions
No, APCM is designed to be billed as a separate per-patient-per-month payment that complements the FQHC Prospective Payment System (PPS) encounter rate, providing a steady stream of non-visit-based revenue.
Tile Healthcare's AI call center automates the collection of SDOH data and chronic care metrics, which directly populates the documentation required for HRSA Uniform Data System (UDS) reporting and quality measure tracking.
Yes, our AI-powered solution provides native-level multilingual outreach, ensuring that underserved and non-English speaking patients are effectively enrolled and managed, which is critical for FQHC equity goals.
The AI handles the heavy lifting of patient identification, outreach, consent, and monthly check-ins, allowing your clinical staff to focus on high-acuity care while the system generates the necessary documentation for billing.
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