Athenahealth APCM Patient Enrollment Checklist

Filter for patients with 2+ chronic conditions using ICD-10 codes relevant to CMS APCM requirements for G0556-G0558.

Cross-reference quality gaps with chronic care eligibility to identify high-priority patients for enrollment.

Verify active Medicare coverage within athenaCollector to ensure eligibility for APCM reimbursement.

Use athena's social determinants of health (SDOH) data to prioritize patients for higher-level APCM billing codes.

Generate a clean CSV export from athenaOne for your AI call center to initiate automated consent outreach.

Configure athenaOne encounter templates to capture required care plan elements for G0556 compliance.

Implement athenaOne Clinical Advisories to alert providers when a patient is eligible for APCM during a visit.

Configure the athena Communicator patient portal to allow patients to view and sign care plans electronically.

Build specific order sets in athenaOne for APCM services to streamline the documentation of care management.

Use athena's 'Patient Flags' feature to visually identify enrolled APCM patients within the schedule.

Add codes G0556, G0557, and G0558 to your practice fee schedule with appropriate Medicare allowable rates.

Work with athena CSC to implement custom claim rules that prevent APCM billing alongside conflicting CCM codes.

Ensure athena billing logic correctly attributes APCM codes to the patient's designated primary care provider.

Create a custom dashboard in athenaCollector to track and resolve holds specific to APCM G-codes.

Confirm POS codes in athena are set correctly for non-face-to-face management services to avoid denials.

Connect your AI phone system via API to sync patient contact data and enrollment status in real-time.

Program AI agents to explain APCM benefits and capture verbal consent according to CMS guidelines.

Ensure every AI outreach attempt and successful enrollment is automatically logged in the athenaOne chart.

Use AI voice automation to schedule the required initiating visit directly into the athenaOne calendar.

Automate the removal of patients from outreach lists within athena when they decline APCM participation.