Question 1

What is APCM for HIV patients?

Accepted Answer

The Accountable Physician Care Model (APCM) for HIV involves coordinated care including antiretroviral therapy management and comorbid condition monitoring. Tile Healthcare’s AI automates the monthly outreach required to satisfy CMS documentation standards, ensuring the practice captures the per-member-per-month payment without increasing staff workload.

Question 2

How does AI improve HIV care plan adherence?

Accepted Answer

AI improves adherence by initiating automated, HIPAA-compliant calls to remind patients of upcoming viral load testing and ARV refills. These interactions are logged directly into the EMR, providing the necessary audit trail for Medicare Chronic Care Management (CCM) billing and improving clinical suppression rates.

Question 3

Can Ryan White patients qualify for Medicare CCM?

Accepted Answer

Yes, patients receiving services through Ryan White programs can often qualify for Medicare CCM if they meet the dual-eligibility criteria. Our AI helps coordinate these benefits by screening patient records for eligibility and managing the specific documentation required to prevent duplicate billing while maximizing revenue.

Question 4

How do we document the 20 minutes required for HIV CCM?

Accepted Answer

Tile Healthcare’s AI platform tracks every second of patient interaction and clinical staff coordination time. This data is automatically aggregated into a report that justifies the 20-minute threshold for CPT code 99490, significantly reducing the administrative burden on infectious disease specialists.

Question 5

Why is long-term monitoring for Hep B eligible for APCM?

Accepted Answer

Chronic Hepatitis B requires lifelong antiviral therapy and regular screening for hepatocellular carcinoma. These ongoing requirements meet the CMS definition of a chronic condition, allowing practices to bill for APCM or CCM services when they provide structured monitoring and care coordination via AI automation.

Question 6

How does AI handle Hepatitis B lab follow-ups?

Accepted Answer

The AI system monitors lab schedules and automatically contacts patients who are overdue for viral load or ALT testing. By closing these gaps in care, the AI ensures the practice meets quality metrics while maintaining the continuous engagement required for chronic care reimbursement.

Question 7

Can we bill for Hepatitis C post-treatment surveillance?

Accepted Answer

While the acute phase is different, post-treatment surveillance for patients with advanced fibrosis or cirrhosis qualifies for chronic care management. AI-driven outreach ensures these high-risk patients remain in the system for regular ultrasound and AFP screening, generating consistent revenue.

Question 8

How does automated outreach reduce lost-to-follow-up rates?

Accepted Answer

By using natural language processing, our AI call system engages patients in a conversational manner to identify barriers to care, such as transportation or pharmacy issues. This proactive approach keeps Hepatitis patients engaged in their treatment plan, which is critical for both health outcomes and billing continuity.

Question 9

What are Infection-Associated Chronic Conditions (IACCI)?

Accepted Answer

IACCI is a CMS category that includes conditions like Long COVID and post-treatment Lyme disease syndrome. These conditions are now recognized as eligible for Chronic Care Management revenue, providing a new pathway for Infectious Disease practices to support patients with complex, multi-system symptoms.

Question 10

How do I bill for Long COVID management?

Accepted Answer

Long COVID management can be billed using CCM codes (99490, 99491) or complex CCM codes (99487) depending on the severity. AI tools assist by documenting the extensive time spent coordinating between specialists, such as cardiology and neurology, which is common in Long COVID cases.

Question 11

What role does AI play in symptom tracking for Long COVID?

Accepted Answer

Tile Healthcare's AI conducts regular, structured symptom assessments for Long COVID patients. This data is fed back to the ID specialist, allowing for data-driven adjustments to the care plan and providing the clinical documentation necessary to support high-level billing codes for complex care.

Question 12

Can chronic Lyme disease qualify for Medicare revenue?

Accepted Answer

Yes, if the patient has two or more chronic conditions or a single complex condition expected to last at least 12 months, they may qualify. AI automation helps ID practices manage the intensive follow-up required for these patients, ensuring all clinical interactions are captured for reimbursement.

Question 13

How does Tile Healthcare integrate with ID-specific EMRs?

Accepted Answer

Our AI solution integrates via HL7 or FHIR API with common EMRs used in infectious disease, such as Epic, Cerner, and AthenaHealth. This ensures that all automated patient outreach and monitoring data is synced in real-time for seamless APCM and CCM billing.

Question 14

Does the AI handle medication adherence checks?

Accepted Answer

Yes, the AI performs automated adherence checks for antiretroviral and antiviral medications. It can identify patients at risk of non-compliance and escalate them to a clinical pharmacist or ID nurse, fulfilling the medication reconciliation requirements of Medicare's chronic care models.

Question 15

How does AI ensure HIPAA compliance during ID patient outreach?

Accepted Answer

Tile Healthcare utilizes end-to-end encryption and secure data protocols. The AI is programmed to verify patient identity before discussing sensitive information related to HIV or Hepatitis, ensuring that all communications meet the highest standards of HIPAA and patient privacy.

Question 16

Can AI identify patients eligible for APCM enrollment?

Accepted Answer

The AI scans your existing patient database to identify individuals with ICD-10 codes associated with HIV, chronic Hepatitis, and IACCI. It then flags these patients for the practice manager, streamlining the enrollment process and ensuring no revenue opportunities are missed.

ID Medicare Chronic Care Revenue & APCM FAQ Guide

APCM and CCM for HIV/AIDS Management

Hepatitis B & C Long-Term Monitoring

Long COVID & IACCI Opportunities

Workflow Automation & Compliance

Ready to transform your infectious disease practice?