How APCM Relates to Existing Care Management Programs

New to the Advanced Primary Care Management model? Check out part one: https://www.doctorsmanagement.com/blog/understanding-advanced-primary-care-management/

How APCM Relates to Current Programs

The Advanced Primary Care Management (APCM) model represents an evolution of care management programs, integrating elements from several existing initiatives while introducing new features. Here’s how APCM compares to and builds upon current programs:

Chronic Care Management (CCM)

APCM expands CCM’s scope to include patients with fewer chronic conditions and simplifies billing with a single monthly payment instead of time-based billing. CCM codes cannot be billed concurrently with APCM, as APCM replaces and expands upon CCM services.

Transitional Care Management (TCM)

APCM includes care transition management, potentially reducing the need for separate TCM billing. However, TCM codes can still be billed separately from APCM when appropriate, covering a specific post-discharge period.

Remote Patient Monitoring (RPM)

While not explicitly included, APCM’s 24/7 access and population health management requirements align with RPM capabilities. RPM codes can be billed concurrently with APCM since they represent a distinct service not fully captured in the APCM bundle.

Behavioral Health Integration (BHI)

APCM does not explicitly include BHI services, allowing BHI codes to be billed concurrently with APCM.

Annual Wellness Visits (AWV)

AWV is not included in the APCM bundle and can be billed separately, allowing practices to continue providing these services alongside APCM.

While APCM replaces some existing care management programs, it allows concurrent billing of certain specialized services, ensuring comprehensive primary care while recognizing the need for specific, intensive interventions.

Billing and Workflow Adjustments

Practices transitioning to APCM must carefully review their billing practices and adjust workflows to maximize reimbursement while avoiding duplicate billing. There are third-party platforms and teams designed to help practices navigate these changes, ensuring compliance with billing rules while optimizing revenue under the new APCM model.

Billing and Flexibility

To bill for APCM services, practices must demonstrate capabilities across all these service elements. However, CMS allows flexibility in service delivery, recognizing that patient needs and services may vary monthly.

Consider Transitioning to APCM in Your Practice

The Advanced Primary Care Management (APCM) model represents a significant shift in how primary care services are delivered and reimbursed. By integrating and expanding upon existing care management programs like CCM and TCM, APCM offers a more flexible and comprehensive approach to patient care. The introduction of tiered HCPCS G-codes ensures that practices receive appropriate reimbursement based on patient complexity while streamlining billing and eliminating time-tracking burdens.

With its focus on care coordination, continuous access, and population health management, APCM enables practices to enhance service delivery, improve patient outcomes, and maintain financial stability. However, transitioning to APCM requires careful planning, workflow adjustments, and compliance with Medicare’s evolving policies. By leveraging technology, data analytics, and expert guidance, practices can successfully implement APCM while optimizing revenue and ensuring high-quality care for their patients.

As the healthcare landscape continues to evolve, APCM positions primary care providers at the forefront of value-based care, promoting a patient-centered approach that enhances both clinical outcomes and operational efficiency.

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