RPM & APCM Enrollment Checklist for Chronic Care | Tile

Verify the patient has at least two chronic conditions that place them at high risk for APCM and require device-based monitoring.

Obtain and record verbal or written consent specifically for RPM and APCM services, explaining potential cost-sharing responsibilities.

Run a real-time eligibility check to ensure the patient has active Part B coverage and check for any secondary insurance.

Assign the MD, NP, or PA who will be responsible for supervising the RPM/APCM program and signing off on monthly care plans.

Link specific diagnosis codes (e.g., I10 for Hypertension) to the required monitoring device to justify medical necessity.

Confirm the patient is not currently enrolled in a competing program that would prevent concurrent RPM and APCM billing.

Select and assign a cellular or Bluetooth BP cuff, glucometer, or pulse oximeter based on the patient's primary chronic condition.

Conduct a baseline reading in the office or via guided AI call to ensure the device is functioning and transmitting correctly.

Educate the patient on how to take daily readings and the importance of the 16-day monthly transmission threshold.

Confirm that the device data is flowing seamlessly from the patient's home to your RPM platform or EHR system.

Distribute simple, large-print instructions for common errors like 'Low Battery' or 'Sync Failed' to minimize device abandonment.

Configure automated AI voice calls or texts to prompt patients who have not submitted a reading within the last 48 hours.

Set custom high/low alerts for each patient so clinical staff are notified immediately of dangerous readings.

Use AI call handling to schedule or conduct initial monthly check-ins, gathering subjective data to pair with RPM stats.

Ensure the latest device readings are automatically pulled into the APCM care plan for the monthly physician review.

Log every minute spent reviewing RPM data and communicating with the patient to satisfy the 20-minute CPT 99457 requirement.

Trigger automated educational content based on specific RPM data trends (e.g., sodium intake tips for high BP readings).

Use standardized EHR templates that capture both RPM data and APCM care coordination activities for audit protection.

Submit the one-time enrollment and education code once the device is successfully deployed and the patient is trained.

Track monthly readings to ensure the 16-day minimum is met before submitting CPT 99454 for device supply.

Verify that time spent on RPM (99457) and APCM is not double-counted, maintaining clear separation in the logs.

Coordinate the submission of RPM management (99457) and APCM codes to ensure consistent monthly revenue flow.

Confirm that private payers or Advantage plans follow Medicare's concurrent billing rules for RPM and APCM.

Analyze the per-patient revenue to ensure the practice is hitting the $150+ target through effective program stacking.