Epic APCM Enrollment Checklist: Chronic Care Workflow Guide

Build custom criteria to filter patients with two or more chronic conditions eligible for APCM based on active Problem List entries.

Ensure the Chronic Disease Management registry is pulling accurate ICD-10 codes from the Problem List and not just billing history.

Use Epic predictive analytics or risk adjustment factor (RAF) scores to prioritize high-need patients for immediate enrollment outreach.

Exclude patients who haven't had a face-to-face visit with an APCM-eligible provider in the last 12 months to meet CMS requirements.

Map Epic coverage records to ensure patients have active Medicare or eligible commercial plans for APCM billing reimbursement.

Connect your AI call center to Epic via FHIR APIs to automatically log enrollment call attempts and results in the patient record.

Set up automated MyChart messages to pre-notify patients about upcoming APCM enrollment phone calls to increase answer rates.

Allow patients to schedule an initial APCM assessment directly through MyChart after an AI-driven outreach call identifies interest.

Use Epic SmartPhrases to quickly record verbal consent obtained during AI-managed enrollment calls for audit compliance.

Ensure the AI system respects Epic 'Do Not Call' and 'Preferred Contact Method' fields to maintain patient satisfaction and compliance.

Create standardized Epic SmartForms to capture all CMS-required elements during the initial care planning session efficiently.

Ensure every APCM care plan is linked to a specific encounter ID for seamless billing and clean audit trails during reporting.

Use Epic 'Resolve' and 'Add' features to ensure the patient active conditions are accurately reflected in the electronic care plan.

Assign patients to specific Epic Care Team folders to track enrollment status and manage the transition to active care management.

Integrate AI call duration data directly into Epic time-tracking activity to ensure accurate APCM minute counts for billing.