1. Understand Eligibility
Confirm your practice's practitioners serve as the continuing, comprehensive primary care focal point for the patients you intend to enroll — this is the core practitioner-level requirement behind APCM.
2. Review Medicare Requirements
Read the current CMS APCM guidance (linked in Official Resources) for the billing, access, and technology requirements described in our APCM Billing Requirements guide.
3. Identify Eligible Patients
Identify patients you already serve as primary care physician or practitioner, and confirm their documented chronic-condition count.
4. Risk-Stratify the Population
Classify each patient into the applicable tier — G0556 (0-1 condition), G0557 (2+ conditions), or G0558 (2+ conditions and QMB status) — based on their current documented profile.
5. Build Care-Management Workflows
Design the recurring workflow for 24/7 access, real-time medical-information access, and successive routine-appointment scheduling with a designated care team member.
6. Assign Staff Roles
Assign who handles urgent-access coverage, care-plan maintenance, asynchronous patient messaging, and post-discharge follow-up.
7. Establish a Communication Process
Stand up secure messaging, a patient portal, or another asynchronous channel beyond phone calls, and the ability to remotely review pre-recorded patient information.
8. Configure Documentation
Implement an electronic, patient-centered comprehensive care plan accessible within and outside the billing practice, with a copy available to the patient or caregiver.
9. Configure Reporting
Set up a way to track which patients are enrolled, their current tier, and whether required documentation (consent, care plan) is current for each.
10. Track Outcomes
Monitor enrollment, tier distribution, and care-coordination activity over time so program trends are visible, not just individual patient records.
11. Review the Billing Process
Confirm each patient is billed under the tier matching their current documented profile, and that only one provider bills APCM per patient per month.
12. Audit the Program Regularly
Periodically re-verify patient tiers, consent documentation, and that the access/communication infrastructure described above remains actually in place — not just billed.