Workflow GuideAllergy & Immunology

Allergy & Immunology Chronic Care Monthly Check-In Workflow

Optimize Allergy & Immunology patient outcomes with this chronic care monthly check-in workflow. Streamline asthma, immunotherapy, and APCM management.

Effective chronic care management in Allergy & Immunology requires structured monthly touchpoints to monitor asthma control, immunotherapy progress, and medication adherence. This workflow leverages AI-driven communication to ensure patients with chronic allergic conditions remain compliant with their care plans while maximizing practice revenue through APCM billing.

The Challenge

Allergy practices often struggle to maintain consistent follow-ups for asthma, immunotherapy, and chronic urticaria patients, leading to missed APCM billing opportunities and increased flare-ups due to non-compliance with inhalers or maintenance shots.

Step-by-Step Workflow

1

Identify Eligible Patients

Filter EHR records for patients with chronic conditions like asthma, primary immunodeficiency, or chronic urticaria who qualify for APCM or CCM services based on insurance and diagnosis codes.

Best Practices
  • Focus on patients with dual chronic conditions for higher APCM reimbursement
  • Include patients on long-term biologics like Xolair or Dupixent
Common Pitfalls
  • Excluding immunotherapy patients who are in the maintenance phase
2

Deploy AI-Powered Outreach

Initiate automated voice calls via AI assistants to schedule or conduct the monthly check-in, ensuring consistent contact without taxing clinical staff time.

Best Practices
  • Set the caller ID to your practice number for higher answer rates
  • Schedule calls during late afternoon when patients are more available
Common Pitfalls
  • Using generic robocalls instead of interactive AI voice agents
3

Conduct Asthma & Respiratory Assessment

Collect Asthma Control Test (ACT) scores and verify inhaler technique and frequency. Identify any increase in rescue inhaler use that may signal an impending flare.

Best Practices
  • Ask specifically about nighttime awakenings due to cough
  • Update the digital asthma action plan based on current scores
Common Pitfalls
  • Accepting 'I feel fine' without recording a numerical ACT score
4

Review Immunotherapy & Biologic Compliance

Verify adherence to maintenance shot schedules or SLIT dosages. Screen for local reactions or systemic symptoms and confirm upcoming clinic appointments for injections.

Best Practices
  • Flag patients who have missed more than two consecutive doses
  • Inquire about skin clearance for patients on eczema biologics
Common Pitfalls
  • Failing to document side effects that require dosage adjustments
5

Epinephrine & Emergency Protocol Check

Confirm the patient has a non-expired epinephrine autoinjector and review the anaphylaxis emergency plan, especially for food allergy and venom immunotherapy patients.

Best Practices
  • Provide an automated reminder for upcoming prescription expirations
  • Ensure the patient knows where their 'trainer' device is located
Common Pitfalls
  • Assuming the patient remembers their emergency protocol without verification
6

Medication Refill & Lab Coordination

Identify needed refills for antihistamines, nasal steroids, or IVIG supplies. Coordinate any necessary laboratory monitoring for patients on immunosuppressants.

Best Practices
  • Sync refills to reduce the number of pharmacy trips
  • Confirm IVIG home infusion schedules for immunodeficiency patients
Common Pitfalls
  • Overlooking the need for periodic IgG level checks
7

Automated Documentation & APCM Billing

The AI logs all patient responses and interaction time directly into the EHR, generating the necessary documentation to support CPT codes for chronic care management.

Best Practices
  • Use a structured template for easy auditing
  • Ensure total clinical time meets the 20-minute monthly threshold
Common Pitfalls
  • Manual data entry that omits the specific minutes spent on care coordination

Expected Outcomes

1

Increased APCM and CCM revenue through automated documentation.

2

Improved ACT scores and asthma control across the patient population.

3

Higher retention rates for patients on long-term immunotherapy.

4

Reduced emergency room visits for anaphylaxis and severe asthma flares.

5

Streamlined administrative workflows for nursing and front-desk staff.

Frequently Asked Questions

The AI uses clinical branching logic to ask specific ACT questions and flags any concerning scores for immediate provider review.

Yes, it tracks shot intervals and reminds patients of their maintenance schedule, flagging those who have missed doses for clinical intervention.

Absolutely. All AI-generated transcripts and data summaries are encrypted and directly integrated into your HIPAA-compliant EHR system.

It ensures every minute of clinical staff or AI interaction is recorded, providing the necessary audit trail for monthly chronic care management codes.

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Allergy & Immunology Chronic Care Monthly Check-In Workflow | Tile Health