Workflow GuideOrthopedics

Orthopedic Chronic Care & APCM Monthly Check-In Workflow

Optimize orthopedic APCM and chronic care billing with our monthly check-in workflow for osteoarthritis, post-op recovery, and osteoporosis management.

Effective chronic care management in orthopedics requires structured communication. This workflow leverages AI automation to ensure patients with osteoarthritis, chronic back pain, and osteoporosis receive the monthly engagement required for APCM billing while improving functional outcomes and surgical recovery through proactive monitoring of home exercise compliance and pain levels.

The Challenge

Orthopedic practices are often too procedure-focused, missing out on recurring revenue because they lack the staff to perform manual 20-minute monthly check-ins for thousands of Medicare patients with chronic musculoskeletal conditions and post-surgical comorbidities.

Step-by-Step Workflow

1

Identify Eligible Patient Panels

Filter your EHR for Medicare patients with two or more chronic conditions such as osteoarthritis and spinal stenosis, or those requiring long-term monitoring post-joint replacement. Prioritize patients with comorbidities like obesity or diabetes that complicate orthopedic recovery.

Best Practices
  • Use ICD-10 codes M15-M19 for osteoarthritis prioritization
  • Cross-reference with surgical history for post-op monitoring
Common Pitfalls
  • Excluding patients who have finished their 90-day global period
  • Overlooking osteoporosis patients
2

Automated Outreach & Monthly Scheduling

Deploy AI-powered calling systems to initiate the monthly check-in. The AI identifies the best time to reach the patient and handles the initial connection, ensuring the practice meets the 20-minute threshold for APCM/CCM billing without exhausting clinical staff.

Best Practices
  • Set calls for mid-morning when elderly patients are most active
  • Ensure the caller ID matches the practice name
Common Pitfalls
  • Using generic robocalls that patients ignore
  • Failing to document the start and end time of the interaction
3

Pain & Functional Assessment (WOMAC/KOOS)

The AI agent conducts standardized functional assessments like the WOMAC for osteoarthritis or KOOS/HOOS for joint replacements. This data tracks the patient's progress and identifies early signs of implant failure or disease progression.

Best Practices
  • Automate the scoring of functional surveys
  • Compare monthly scores to detect significant declines
Common Pitfalls
  • Recording vague pain descriptions instead of standardized scores
  • Ignoring changes in mobility aids
4

Medication & HEP Compliance Review

Review adherence to prescribed NSAID protocols and Home Exercise Programs (HEP). The AI identifies barriers to physical therapy and provides reminders for osteoporosis medications like bisphosphonates to ensure bone density goals are met.

Best Practices
  • Ask specific questions about home exercise frequency
  • Verify if refills are needed for chronic pain meds
Common Pitfalls
  • Assuming patients are doing their exercises correctly
  • Failing to document medication side effects
5

Fall Risk & Home Safety Screening

For elderly orthopedic patients, the AI conducts a monthly fall risk assessment. This includes checking for home hazards and ensuring the patient is following fall prevention guidelines provided during their last clinic visit.

Best Practices
  • Focus on patients with recent lower extremity surgery
  • Incorporate the CDC STEADI tool questions
Common Pitfalls
  • Skipping fall risk for younger chronic back pain patients
  • Not escalating high-risk responses to the surgeon
6

APCM Documentation & Billing Capture

Automatically transfer the call transcript, functional scores, and time spent into the EHR. Ensure the documentation clearly supports the medical necessity of the 20-minute clinical interaction for APCM billing purposes.

Best Practices
  • Use structured templates for the monthly summary
  • Ensure the surgeon reviews and signs off on high-risk flags
Common Pitfalls
  • Incomplete time logs that lead to audit recoupment
  • Failing to link the check-in to the specific care plan

Expected Outcomes

1

Increased recurring monthly revenue via APCM and CCM codes

2

Reduced post-operative readmission rates for joint replacement patients

3

Improved patient satisfaction through consistent, proactive communication

4

Higher compliance with physical therapy and home exercise protocols

5

Early detection of surgical complications or disease progression

Frequently Asked Questions

Generally, care related to the surgery is included in the global period. However, APCM can be billed for managing unrelated chronic conditions like osteoporosis or contralateral osteoarthritis, provided the documentation clearly separates the two.

Our AI is trained on musculoskeletal-specific language models, allowing it to accurately understand and transcribe terms like 'spinal stenosis', 'rotator cuff', and 'arthroplasty' while interacting with patients.

Requirements include at least 20 minutes of clinical staff time per month, a certified EHR, a comprehensive care plan, and the management of two or more chronic conditions expected to last at least 12 months.

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Orthopedic Chronic Care & APCM Monthly Check-In Workflow | Tile Health