Workflow GuideAdvancedMD

Chronic Care Risk Stratification for AdvancedMD Users

Master APCM risk stratification in AdvancedMD. Identify eligible patients, automate outreach, and optimize billing workflow for independent practices.

Optimizing risk stratification within AdvancedMD is the foundation for a successful Advanced Primary Care Management (APCM) program. By leveraging AdvancedMD's reporting and billing modules, independent practices can identify high-risk chronic patients and automate the documentation required for CMS reimbursement.

The Challenge

Independent practices using AdvancedMD often lack the administrative bandwidth to manually identify and contact patients eligible for APCM, leading to significant lost revenue and fragmented care for high-risk individuals.

Step-by-Step Workflow

1

Data Mining via Custom Reports

Leverage the AdvancedMD Custom Report Builder to extract patient lists filtered by multiple ICD-10 codes. This allows you to isolate patients with two or more chronic conditions who qualify for APCM services under the latest CMS guidelines.

Best Practices
  • Use the 'Diagnosis' filter in the AdvancedMD report builder.
  • Save the report as a favorite for monthly auditing.
Common Pitfalls
  • Filtering only by primary diagnosis instead of all active problems.
2

Risk Score Calculation

Utilize the 'Patient Dashboard' within the AdvancedMD EHR to assign risk tiers. Focus on patients with high emergency department utilization or those who have not had a wellness visit in the last six months.

Best Practices
  • Cross-reference risk scores with AdvancedMD's 'Health Watch' alerts.
  • Update risk tiers during every annual wellness visit.
Common Pitfalls
  • Ignoring social determinants of health data available in patient demographics.
3

Automated Outreach Integration

Integrate your AdvancedMD patient lists with an AI-powered call center. This automation handles the initial outreach, explaining APCM benefits and securing patient consent without taxing your front desk staff.

Best Practices
  • Sync AI outreach logs directly to AdvancedMD patient notes.
  • Use AI to verify current contact information.
Common Pitfalls
  • Failing to update the 'Do Not Call' list in AdvancedMD.
4

Billing Module Setup

Configure the AdvancedMD 'Billing Master' module with the necessary APCM G-codes. Ensure that these codes are linked to the appropriate provider IDs and practice locations to prevent claim rejections during the submission process.

Best Practices
  • Link G-codes to the APCM-specific fee schedule.
  • Test the billing rules in the AdvancedMD sandbox first.
Common Pitfalls
  • Using generic CCM codes instead of the new APCM-specific G-codes.
5

Template Configuration

Create custom 'Note Templates' in AdvancedMD EHR specifically for APCM encounters. These templates should include checkboxes for required documentation elements like medication reconciliation and care plan updates.

Best Practices
  • Enable 'Quick Text' for repetitive APCM documentation.
  • Set mandatory fields for risk stratification metrics.
Common Pitfalls
  • Leaving the care plan documentation too vague for CMS auditors.
6

Engagement Tracking

Monitor program success using the 'Practice Management Reporting' dashboard. Track the volume of stratified patients versus those successfully enrolled to identify bottlenecks in your APCM workflow.

Best Practices
  • Schedule the 'Practice Productivity' report to run weekly.
  • Compare APCM revenue against previous CCM benchmarks.
Common Pitfalls
  • Failing to reconcile denied APCM claims in the AdvancedMD claim center.

Expected Outcomes

1

Increased APCM enrollment rates

2

Automated identification of high-risk patients

3

Seamless G-code billing integration

4

Reduced administrative burden for small practices

5

Improved clinical outcomes via proactive care

Frequently Asked Questions

AdvancedMD allows you to build custom reports based on ICD-10 codes. By filtering for patients with multiple chronic conditions and cross-referencing with active insurance, you can generate a precise list of APCM-eligible candidates.

While the EHR doesn't automatically bill, you can set up 'Macro' codes and billing templates in the AdvancedMD Billing module. This allows your staff to drop APCM G-codes into a claim with a single click after documentation is complete.

AI call handling integrates with your AdvancedMD schedule to perform proactive outreach. It identifies patients due for a chronic care check-in and can even update patient status fields in the EHR via API integration.

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Chronic Care Risk Stratification for AdvancedMD Users | Tile Health