Urology Chronic Care Patient Enrollment Checklist

Flag Medicare patients with N40.1 diagnoses requiring ongoing monitoring for urinary retention or medication side effects.

Filter for patients with recurrent nephrolithiasis who require metabolic monitoring and frequent hydration counseling.

Identify patients on long-term anticholinergics or beta-3 agonists who benefit from monthly symptom assessment.

Isolate patients in the 5-10 year surveillance window needing structured PSA tracking and erectile dysfunction management.

Flag patients requiring chronic lab monitoring for hematocrit levels and PSA changes while on replacement therapy.

Ensure the patient has at least two chronic conditions expected to last 12 months, such as BPH combined with hypertension.

Capture verbal or written consent specifically for chronic care services, explaining the potential 20% Medicare coinsurance.

Verify the patient has been seen by the urologist or APP within the last year to establish the care relationship.

Document how patients can reach the urology care team after hours, a core requirement for APCM/CCM billing.

Develop a structured document in the EMR that includes urologic goals, medications, and expected surgical interventions.

Perform a full review of urologic medications and their interactions with the patient's other chronic prescriptions.

Use specific urology-tailored templates to record the start date and time spent on the enrollment call.

Use automated voice agents to call eligible BPH patients and explain the benefits of monthly monitoring and care coordination.

Set up AI calls to collect International Prostate Symptom Scores before the patient arrives for their quarterly check-up.

Automate outbound reminders for post-prostate cancer patients to ensure they complete their scheduled lab work on time.

Schedule automated monthly touchpoints focused on hydration goals and dietary compliance for chronic stone formers.

Train the AI call handler to answer common questions regarding Medicare coverage for urologic chronic care management.

Ensure the AI system records and timestamps patient consent, automatically uploading the audio file to the patient chart.