NextGen APCM Revenue Guide: Medicare Chronic Care FAQ

Maximize Medicare chronic care revenue in NextGen Healthcare. Learn how AI call handling and workflow automation streamline APCM billing and documentation.

Optimizing Medicare Chronic Care Management (CCM) and Advanced Primary Care Management (APCM) within NextGen Healthcare requires a blend of precise documentation and proactive patient engagement. Tile Healthcare’s AI call center solutions integrate with your NextGen workflows to capture billable minutes, automate outreach, and ensure your practice captures maximum revenue.

NextGen PM & Billing Setup

4 questions

To bill APCM codes like G0511 or 99490, you must update your NextGen PM master files with the correct CPT/HCPCS codes and link them to the appropriate fee schedules. Tile Healthcare assists by ensuring every patient interaction is logged with precise timestamps that map directly to these billing requirements.

Most APCM claims in NextGen require specific modifiers such as the 25 modifier if an E/M visit occurs on the same day. Ensure your NextGen billing rules engine is configured to flag these interactions to prevent bundling denials and ensure full reimbursement for chronic care services.

NextGen’s Care Management module allows for manual time logging, but Tile Healthcare automates this by tracking the exact duration of AI-led patient interactions. This data can be pushed via API or documented in the patient chart to satisfy CMS audit requirements for time-based billing.

While NextGen can generate claims based on documented encounters, the trigger often requires manual review. By using AI to handle the initial patient outreach and documentation, your staff only needs to perform a final review in the NextGen PM worklog before submission.

NextGen PM & Billing Setup

How do we configure APCM codes in NextGen PM?

What modifiers are needed for APCM in NextGen?

How does NextGen track the 20-minute care threshold?

Can NextGen automate APCM claim generation?

Patient Identification & Outreach

How do we identify APCM-eligible patients in NextGen?

Use the NextGen Population Health tool to filter patients by chronic condition ICD-10 codes and Medicare insurance status. Once identified, Tile Healthcare’s AI can automatically initiate outreach calls to enroll these patients into your APCM program according to your customized criteria.

Can Tile Healthcare update NextGen patient enrollment status?

Yes, through secure API integration or automated note entry, Tile Healthcare can update the 'Care Management' status field in NextGen EHR. This ensures your clinical team knows exactly who is enrolled in APCM and who requires immediate follow-up or care plan adjustments.

How do we manage consent for APCM within NextGen?

CMS requires verbal or written consent for APCM. Tile Healthcare’s AI can obtain and record verbal consent during the initial outreach call, documenting the timestamp and agreement directly into the NextGen EHR encounter notes for strict regulatory compliance.

Does AI outreach work with NextGen Mobile?

Yes, while AI handles the high-volume calling and data gathering, your providers can view the results and updated care plans via NextGen Mobile, allowing for seamless care coordination and visibility even when providers are away from their desktop workstations.

Optimizing Care Management Workflows

How does AI reduce the burden on NextGen care coordinators?

NextGen care coordinators often spend hours on phone tag. Tile Healthcare’s AI handles routine monthly check-ins, symptom monitoring, and medication reconciliation, only escalating complex clinical issues to the coordinator’s NextGen task queue for professional intervention.

Can AI assist with NextGen HEDIS and Quality reporting?

By ensuring consistent monthly contact with chronic care patients, Tile Healthcare helps close gaps in care. The data gathered is documented in NextGen, which feeds into your Quality Dashboard to improve HEDIS scores and overall MIPS performance metrics.

How are AI call logs recorded in the NextGen EHR?

Every AI-driven interaction is transcribed and summarized into a clinical note. This note is then pushed into the NextGen EHR under the appropriate encounter type, ensuring a complete longitudinal record of the patient's chronic care journey for audit and clinical purposes.

Does this solution support NextGen’s API for real-time data?

Tile Healthcare utilizes NextGen’s Mirth Connect or the NextGen API (NGAPI) to ensure bi-directional data flow. This allows for real-time updates to patient records, ensuring that the AI has the most current clinical context for every patient interaction.

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NextGen APCM Revenue Guide: Medicare Chronic Care FAQ

NextGen PM & Billing Setup

Patient Identification & Outreach

Optimizing Care Management Workflows

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