Starting January 1, 2025, CMS launched something new called Advanced Primary Care Management or APCM. This matters for primary care doctors who work with Medicare patients, especially those with ongoing health problems.
If you run a primary care practice, APCM billing might help you get paid for work you already do. But you need to understand how it works to bill correctly.
What Is APCM?
APCM lets you bundle all the extra care work you do for patients into one monthly service. This includes coordinating care between specialists, checking in with patients between visits, helping them manage medications, and planning preventive care.
The best part is that APCM billing does not make you track every minute of your time. You can bill once a month per patient if you meet the clinical requirements.
This is much easier than traditional time-based codes that force you to document everything.
Who Can Bill for APCM?
Not everyone can use these codes. You need to be the primary care provider for the patient and have an established relationship with them.
These codes work for primary care specialties like family medicine, internal medicine, general practice, and geriatrics.
The patient needs to agree to the services and you should write that down in their chart.
The Three APCM Codes
There are three codes and which one you use depends on how sick your patient is.
G0556 is for basic chronic care management. Use this for patients who have one or more chronic conditions that need regular attention.
G0557 is for patients who need more help. This works for people with moderate to severe conditions or multiple health problems.
G0558 is the highest level. Bill this for patients with serious chronic conditions or complicated medical situations that need lots of care coordination.
Each level includes the same basic services but the higher codes need more work based on what the patient needs.
What Services Do You Need to Provide
You need to offer certain services when they make sense for the patient to bill any APCM code. This includes creating and updating a care plan, coordinating care with other doctors and community resources, managing medications, reaching out to patients between office visits, making sure patients can reach someone on your team all day and night, helping patients when they leave the hospital, teaching them about their conditions, and tracking test results and referrals.
Your staff can handle many of these tasks under general supervision if they meet Medicare incident to billing rules.
Why APCM Is Better?
Providers struggled with time-based care management codes for years. You had to track minutes, hit certain numbers, and spend tons of time on paperwork.
APCM billing fixes this. You bill based on what you do, not how long it takes. This means less paperwork and more time helping patients.
It also pays well. The money you get for APCM is good and you get paid for work you probably do anyway but could not bill for before.
APCM also helps with your reporting. When you write down APCM services the right way, you also capture data that supports your quality measures. Many practices use a MIPS registry to track this information and make MVP reporting easier at the end of the year.
How APCM Works with Healthcare Requirements?
If you already deal with MIPS healthcare reporting, APCM services can help you. The care coordination and patient work you document for APCM billing often match the quality measures you need for MIPS reporting.
When you track care plans, medication management, and care coordination for APCM billing, you build paperwork that supports your MIPS data. This makes MVP reporting less annoying because you capture the information anyway.
Many providers find that their reporting gets better when they start using APCM codes because they write down care more carefully.
Getting Started
The switch to APCM billing does not have to be hard. Start by finding which patients qualify. Look for those with chronic conditions who need regular follow-up and care coordination.
Make sure your team knows what services count toward APCM and how to document them. You do not need to track time but you do need to show that you provided the required services.
Set up systems for your staff to handle outreach, care coordination, and paperwork. Remember that they can do most of this work under supervision, which makes it easier to grow.
Train everyone on the three code levels so they know which one to use based on how complicated the patient is.
Mistakes to Avoid
Do not try to bill APCM for the same services you already bill under other care management codes. You cannot use both.
Make sure the patient agreed to APCM services and that it is written down. CMS can check these records.
Remember that APCM is a monthly billing. You can only bill once per patient per calendar month, even if you provide many services.
Keep good records of what services you provide, even though you are not tracking time. You still need proof that you met the requirements.
What This Means for Your Practice
APCM changes how Medicare pays for primary care. Instead of making it hard to bill for care coordination and patient outreach, it rewards you for it.
The billing is easier than old time based codes. The payment is good. And you probably already do most of the work anyway.
As healthcare keeps moving toward value-based care, APCM gives you a way to get paid fairly while making patients healthier. MIPS reporting company supports your work and helps document the quality care you give every day.
For practices that want to succeed with APCM billing, having the right support makes all the difference. You need a team that understands the rules, knows how to document correctly, and can handle claims without errors.
We helps practices like yours handle APCM billing the right way. We know the ins and outs of medical billing so you can focus on patients. Whether you need help with claims, management, or MVP reporting, we know to make it work.
Our team stays up to date on all CMS changes and requirements. We make sure your APCM billing is accurate, compliant, and gets you the money you deserve. We also help connect your APCM services to your MIPS healthcare reporting so everything works together.
When you work with us, you get more than just billing help. You get a partner who understands primary care, knows what reporting requires, and can help you use APCM billing to grow your practice.
Contact us today to learn how we can make your APCM billing smooth and get you the most money back.
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