APCM Patient Enrollment Checklist for Solo Practices

Search your EMR for patients with two or more chronic conditions expected to last at least 12 months, such as hypertension, diabetes, or COPD.

Verify that patients are covered under traditional Medicare or Medicare Advantage, as solo practitioners must be the billing entity.

Ensure a qualifying E&M visit, Annual Wellness Visit (AWV), or Initial Preventive Physical Exam (IPPE) occurred within the last 12 months.

Prioritize patients with frequent ER visits or complex medication lists to maximize clinical impact and practice ROI.

Confirm the patient is not currently enrolled in similar services like Home Health or Hospice that might conflict with APCM billing.

Set up automated outreach scripts that explain the benefits of APCM and the 24/7 care access provided by your practice.

Use the AI system to record patient agreement to participate, ensuring the timestamped record is stored for compliance.

Inform patients about potential 20% co-insurance requirements if they do not have supplemental or secondary insurance.

Ensure patients are informed they can stop the service at any time, which is a key Medicare requirement for solo practices.

Automatically email or mail a practice-branded brochure explaining how the 24/7 AI-powered phone line supports their care.

Create a patient-centered plan covering physical, mental, and social goals using standardized APCM templates.

List all current medications and establish a schedule for regular review and reconciliation via the AI care team.

Verify that the AI call center is correctly routing urgent after-hours concerns to the physician while handling routine queries.

Implement a system to log the required 20 minutes of non-face-to-face care management time per patient per month.

Incorporate the care plan review into the next scheduled office visit to satisfy the physician-led oversight requirement.

Confirm that your solo practice NPI is correctly registered in the Medicare PECOS system for APCM billing.

Ensure codes 99490 (initial 20 mins) and 99439 (subsequent 20 mins) are active in your EMR or clearinghouse.

Document that all care management activities are performed under your general supervision as the solo provider.

Maintain a digital log of all AI-driven patient interactions to provide evidence of service in case of a Medicare audit.

Track total enrolled patients versus successfully billed units to ensure the program is meeting revenue targets.