Athenahealth APCM Revenue: Medicare Chronic Care FAQ Guide

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.