AWV & Chronic Care Enrollment Checklist | Tile Healthcare

Use AI voice agents to call eligible Medicare patients who have not had their annual visit in the last 12 months.

Send digital HRAs via SMS or email to identify chronic conditions and social determinants of health before the encounter.

Cross-reference patient records for two or more chronic conditions during the automated scheduling call to flag for enrollment.

Confirm Medicare Part B coverage for G0438 or G0439 codes to ensure seamless reimbursement for the practice.

Deploy automated multi-channel reminders to reduce no-show rates for these high-value preventive wellness encounters.

Review HRA responses during the visit to identify gaps in care and validate existing or new chronic diagnoses.

Use the AWV clinical findings to initiate the comprehensive care plan required for recurring APCM billing.

Secure and document verbal or written consent for APCM services during the AWV to allow for immediate enrollment.

Integrate depression screening (PHQ-9) and functional ability assessments as part of the mandated AWV components.

Reconcile all medications to identify potential risks or the need for intensive chronic management through APCM.

Ensure all required elements of the Initial or Subsequent AWV are documented within the EHR to prevent claim denials.

Prepare billing for APCM services alongside the AWV, ensuring the patient meets the criteria for two or more chronic conditions.

If billing CCM or APCM on the same day, ensure time spent is documented as distinct from the AWV preventive service.

Ensure the EHR reflects all chronic conditions identified during the HRA for accurate risk adjustment and HCC coding.

Use AI to automate the 30-day follow-up call required to maintain APCM engagement and verify care plan adherence.