Question 1

How do I configure athenaOne for APCM documentation?

Accepted Answer

To document APCM in athenaOne, you should utilize the 'Care Management' section within the clinical encounter. Configure custom encounter types specifically for APCM interactions and ensure that your care plan templates are updated to include the required CMS elements for chronic care coordination and patient consent.

Question 2

What specific templates should be used for chronic care management?

Accepted Answer

Use athenaOne's 'Care Plan' templates and customize them with specific fields for chronic condition tracking. You can build macros for common APCM workflows to ensure consistent documentation across your clinical staff, making it easier to meet the CMS requirements for the new G-codes.

Question 3

Can I track time spent on APCM within athenahealth?

Accepted Answer

Yes, athenaOne includes time-tracking features within clinical encounters. For APCM, you can use the 'Time Spent' field or custom flowsheets to log the non-face-to-face care coordination time required for higher-level billing, ensuring all billable minutes are captured for G0557 and G0558.

Question 4

How do I set up custom tasks for APCM follow-ups?

Accepted Answer

Utilize athenahealth's 'Tasking' rules to automatically route APCM follow-up reminders to specific clinical buckets. By setting up automated task generation based on patient attributes, you ensure that no chronic care patient falls through the cracks between scheduled visits.

Question 5

Does Athenahealth have built-in APCM reporting?

Accepted Answer

Athenahealth provides robust reporting through the 'Report Builder' and 'Report Designer' tools. You can create custom reports to track APCM enrollment status, identify patients who haven't had their monthly care coordination, and monitor the status of G-code claim submissions.

Question 6

How do I identify APCM-eligible patients in Athenahealth?

Accepted Answer

Use the athenaOne Report Builder to filter your patient population by insurance type (Medicare/Medicare Advantage) and ICD-10 codes associated with chronic conditions. This allows you to generate a targeted list of patients eligible for the G0556-G0558 revenue stream.

Question 7

Can I automate patient consent collection through athenahealth?

Accepted Answer

You can use the athenahealth Patient Portal and automated messaging tools to send consent forms. However, for higher conversion, many practices use AI-driven phone outreach to explain the benefits of APCM and capture verbal consent, which is then documented directly in the patient's chart.

Question 8

What is the best way to handle high-volume outreach for APCM?

Accepted Answer

High-volume outreach is best handled by integrating AI call automation with your athenaOne database. AI agents can contact eligible patients, explain the APCM program, and schedule the necessary initiating visits, significantly reducing the manual workload for your front office staff.

Question 9

How do I manage patient communication preferences for chronic care?

Accepted Answer

In the athenaOne patient chart, navigate to the 'Communication' tab to set preferences for APCM outreach. Integrating AI call handling ensures these preferences are respected, as the system can automatically check for 'Do Not Call' or 'Text Only' flags before initiating outreach.

Question 10

How can I track which patients have been contacted for APCM?

Accepted Answer

You can track outreach efforts by creating a custom 'Patient Attribute' or using specific 'Task Statuses' in athenahealth. AI automation tools can automatically update these fields via API as soon as an outreach call is completed, providing real-time visibility into your enrollment funnel.

Question 11

Which CPT codes are used for APCM in Athenahealth?

Accepted Answer

The primary codes for Advanced Primary Care Management are G0556 (Basic), G0557 (Moderate), and G0558 (Complex). These codes must be added to your athenahealth fee schedule and mapped to the appropriate provider types to ensure accurate claim generation.

Question 12

How do I configure athenaCollector for APCM billing rules?

Accepted Answer

Work with your athenahealth CSM or billing specialist to configure 'Claims Engine' rules. These rules can prevent G0556-G0558 claims from being submitted if a qualifying initiating visit (like an AWV) hasn't occurred within the last 12 months, reducing the risk of denials.

Question 13

What documentation is required in the athena chart for an APCM claim?

Accepted Answer

CMS requires a comprehensive care plan, 24/7 access to care, and documentation of care coordination. Ensure your athenaOne clinical notes clearly reflect these elements, specifically citing the care manager's interactions and any patient-facing communications handled by your staff or AI.

Question 14

How does Athenahealth handle the 'initiating visit' requirement?

Accepted Answer

Athenahealth can track the date of the last Annual Wellness Visit (AWV) or E/M encounter. You can set up an 'Alert' in the patient's chart that triggers when a patient is eligible for APCM but lacks the required initiating visit, prompting providers to address it during the next encounter.

Question 15

Can I automate the claim submission for G0556 codes?

Accepted Answer

Yes, by using athena's billing automation features, you can set up monthly recurring billing for APCM. Once the care requirements are documented in the clinical record, the system can automatically drop the charge for the appropriate G-code into the billing tab for review.

Question 16

How does AI call handling integrate with my Athenahealth workflow?

Accepted Answer

AI call handling systems like Tile Healthcare integrate via API or secure data exchange to read patient lists from athenaOne. The AI handles the outreach and then pushes interaction logs or scheduling data back into the athena clinical record, creating a seamless loop for APCM management.

Question 17

Can AI agents document calls directly into the athenaOne patient record?

Accepted Answer

Yes, advanced AI platforms can generate automated call summaries and post them as 'Clinical Notes' or 'Administrative Tasks' within athenaOne. This ensures that every APCM-related patient interaction is documented for compliance without manual data entry by your staff.

Question 18

How does phone automation improve APCM enrollment rates?

Accepted Answer

AI automation allows for consistent, persistent outreach that manual staff often cannot maintain. By reaching out to patients at optimal times and providing immediate answers to questions about APCM, AI agents can significantly increase the number of patients who consent to the program.

Question 19

Can AI handle the 24/7 access requirement for APCM?

Accepted Answer

One of the key requirements for APCM is 24/7 access to care. AI call handling provides a cost-effective way to meet this mandate, offering patients an immediate point of contact after hours that can triage needs, provide information, and document the encounter in athenaOne.

Question 20

Does AI automation reduce the burden on my front desk?

Accepted Answer

By automating the time-consuming tasks of identifying, contacting, and consenting patients for APCM, AI allows your front desk to focus on in-person patient care. This eliminates the 'phone tag' common in chronic care management and ensures a steady stream of APCM revenue.

Athenahealth APCM Revenue: Medicare Chronic Care FAQ Guide

Athenahealth Configuration & Setup

Patient Identification & Outreach

Billing & Compliance in athenaOne

AI Automation & Call Handling

Ready to transform your athenahealth practice?