CCM to APCM Enrollment Checklist | Transition Guide

Pull reports of all patients currently billed under 99490 or 99491 to establish your migration baseline.

Assign patients to Level 1, Level 2, or Level 3 based on CMS APCM risk-stratification criteria.

Model the financial difference between 20-minute CCM billing and the new monthly APCM flat rates.

Calculate the administrative cost savings from eliminating the 20-minute documentation threshold.

Create a financial forecast based on stratified patient counts and their respective APCM codes.

Revise forms to reflect APCM service elements, including 24/7 access and risk-based management.

Clearly communicate to patients that APCM is replacing their current CCM service structure.

Secure consent for APCM, ensuring patients understand the shift in care delivery and potential cost-sharing.

Ensure a time-stamped record of consent is available before the first APCM billing cycle starts.

Use AI call handling to contact patients for re-enrollment, handling high-volume outreach efficiently.

Stop requiring staff to log every minute; shift focus to task completion and patient contact.

Set up AI call handling to prioritize high-risk APCM patients for immediate clinical intervention.

Use software to alert staff when a patient's status suggests a shift in APCM risk level.

Use AI transcription to summarize care coordination calls directly into the patient's record.

Educate the team on moving from 'hitting 20 minutes' to 'delivering comprehensive care'.

Verify care plans include all required APCM elements, such as social determinants and risk assessments.

Capture all coordination activities, even those that don't meet previous CCM time minimums.

Document Social Determinants of Health, as these often influence APCM risk stratification levels.

Ensure every billed APCM code is supported by a corresponding clinical note for that month.

Maintain logs showing patients have access to care 24/7, a core requirement of APCM.

Prevent accidental billing of 99490 for patients who have transitioned to APCM.

Ensure the latest CMS APCM codes are correctly entered into your practice management software.

Set up system edits to block billing CCM and APCM for the same patient in the same month.

Review the first batch of APCM claims to ensure risk levels match clinical documentation.

Coordinate with your clearinghouse to ensure they recognize and process the new APCM codes.