Workflow GuideNextGen Healthcare

NextGen APCM Chronic Care Monthly Check-In Workflow Guide

Optimize NextGen Healthcare APCM workflows with this guide on monthly check-ins, billing setup, and AI-powered patient outreach for chronic care.

This workflow guide provides a step-by-step blueprint for NextGen Healthcare practices to execute monthly Advanced Primary Care Management (APCM) check-ins. By leveraging NextGen’s Population Health tools and AI-driven call automation, practices can efficiently manage chronic disease burdens, ensure regulatory compliance, and capture monthly revenue without overwhelming clinical staff.

The Challenge

Many NextGen practices struggle with manual outreach and fragmented documentation for APCM, leading to missed billing opportunities. Without a structured workflow that integrates NextGen PM with automated engagement, staff spend excessive time on administrative tasks rather than patient care.

Step-by-Step Workflow

1

Identify Eligible Patients in PopHealth

Use NextGen Population Health (PopHealth) dashboards to filter for patients with multiple chronic conditions and active APCM consent forms stored in the Document Management system. This ensures your outreach list is compliant and targeted.

Best Practices
  • Filter by specific ICD-10 codes
  • Verify active consent status in the chart
Common Pitfalls
  • Ignoring the consent expiration date
  • Mixing CCM and APCM patient cohorts
2

Deploy AI-Powered Outreach

Utilize AI call handling via API integration to execute monthly check-in calls. The AI captures patient status updates, screens for new symptoms, and feeds data directly back into NextGen, reducing the need for manual MA dialing.

Best Practices
  • Schedule calls during peak engagement hours
  • Use natural language AI for higher response rates
Common Pitfalls
  • Relying on manual staff calls for all patients
  • Inconsistent logging of call outcomes
3

Document Care Coordination in EHR

Navigate to the NextGen EHR Care Management template to document the 20-minute threshold of non-face-to-face care coordination. Use structured data fields to ensure that all CMS documentation requirements for APCM are met.

Best Practices
  • Use auto-narrative features to speed up entry
  • Timestamp all coordination activities
Common Pitfalls
  • Entering vague clinical notes
  • Failing to reach the 20-minute billing minimum
4

Update Medication Reconciliation

Conduct a thorough medication reconciliation within the NextGen Clinical module. Update the medication grid and check for new prescriptions from outside providers via Surescripts integration to ensure safety and adherence.

Best Practices
  • Check external prescription fill history
  • Review potential drug-drug interactions
Common Pitfalls
  • Skipping the medication grid update
  • Ignoring over-the-counter supplements
5

Refresh the Patient Care Plan

Update the patient-centered care plan in the NextGen Care Management module. Ensure that all goals and interventions are aligned with the latest clinical data and share the updated plan with the patient via the portal.

Best Practices
  • Print or publish the plan to the patient portal
  • Set follow-up tasks for the next month
Common Pitfalls
  • Leaving static care plans unchanged
  • Setting non-patient-centered goals
6

Queue APCM Billing in NextGen PM

Queue the APCM encounter in NextGen PM, applying the necessary billing codes and modifiers. Run the claim through the built-in scrubber to check for CCI edits before final submission to the clearinghouse.

Best Practices
  • Automate claim scrubbers for APCM codes
  • Verify insurance eligibility monthly
Common Pitfalls
  • Applying the wrong modifier
  • Duplicate billing within the same 30-day period

Expected Outcomes

1

Enhanced NextGen PM billing efficiency and revenue capture

2

Higher patient compliance and retention in chronic care programs

3

Reduced staff burnout through AI-driven call automation

4

Improved population health metrics for specialty practices

5

Full compliance with CMS APCM documentation requirements

Frequently Asked Questions

NextGen allows users to track non-face-to-face time using specific care management templates or custom tasking workflows that log cumulative minutes spent on patient coordination.

Yes, via API integration, AI call solutions can check the NextGen schedule and update patient status in real-time based on the outcome of the monthly check-in.

Practices typically use CPT codes like 99490 or specific APCM codes defined by CMS, ensuring the NextGen PM master files and fee schedules are updated accordingly.

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NextGen APCM Chronic Care Monthly Check-In Workflow Guide | Tile Health