Healthcare is about more than what happens during routine appointments or hospital visits. To provide more consistent, supportive care, advanced primary care management services offer an elevated level of support for patients with chronic health conditions.

A Brief Guide to Advanced Primary Care Management (APCM)

Providers can support effective advanced primary care management (APCM) by providing resources – including remote patient monitoring (RPM) devices and platforms – to increase touchpoints and break down barriers. Here’s what you need to know about delivering, coordinating, and billing for APCM services alongside RPM.

What is Advanced Primary Care Management (APCM)?

APCM describes a higher level of care offered for those with one or more chronic conditions. It’s a way for providers to help patients manage ongoing health problems during and, especially, between visits.

APCM ensures that patients receive continuous support. In order to bill for APCM, a provider must:

  • Acquire patient consent
  • Provide necessary treatment, including preventative care
  • Create a comprehensive care plan
  • Offer Transitional Care Management
  • Manage care for patients with multiple chronic conditions
  • Provide 24/7 access to care
  • Focus on long-term patient relationships by checking in regularly
  • Coordinate care with any additional providers
  • Provide support or resources for social needs, such as housing and food insecurity
  • Track quality and performance through programs like the MIPS Value Pathway

APCM vs. Traditional Chronic Care Management (CCM)

APCM expands on basic CCM. It includes everything that CCM does and more.

Where CCM primarily focuses on helping patients manage long-term health conditions through care plans and regular check-ins, APCM goes beyond those requirements.

It emphasizes consistent patient communication, broader care coordination, and 24/7 access to care.

Examples of Advanced Primary Care Services

Here are some ways providers can ensure they are meeting APCM requirements:

  • Create a personalized health plan to manage chronic health conditions, like high blood pressure and diabetes.
  • Give patients 24/7 access to care through phone calls, messaging, text, video chats, etc.
  • Teach patients to manage ongoing health conditions at home.
  • Use virtual care options to monitor conditions between visits and offer pathways for virtual communication, like secure instant messaging, phone check-ins, and video calls.
  • Track performance and quality of care.
  • Check in with patients after hospital visits (Transitional Care).
  • Help patients schedule follow-up appointments and share any pertinent test results with additional relevant providers.
  • Offer or arrange social support to address concerns like transportation, food insecurity, etc.
  • Use technology, like healthcare apps, for more thorough patient engagement.

APCM and Remote Patient Monitoring (RPM)

RPM devices can help providers meet APCM requirements by enabling patients to manage complex conditions between appointments. These devices give providers access to crucial health data and allow them to support patients remotely.

Since APCM prioritizes greater access to care and more support between visits, RPM is especially useful for rural patients or those with limited transportation access.

Advanced Primary Care Management Codes & Reimbursement

There are three billing codes for APCM services, and they are categorized as follows.

Advanced Primary Care Management (APCM)

HCPCS Code

Description

G0556

  • APCM services are provided for patients with one chronic condition.

G0557

  • APCM services are provided for patients with two or more chronic conditions.

  • These conditions must be expected to continue for at least 12 months or until death.

  • These conditions place the patient at risk of death, acute complications, or functional decline.

G0558

  • APCM services are provided for low-income patients who receive coverage through the Centers for Medicare and Medicaid Services (CMS) and are qualified Medicare beneficiaries with two or more chronic conditions.

  • These conditions must also meet the requirements of the previous billing code.

For each billing code, the services provided must fulfill all the outlined APCM requirements.

Discover New Ways to Improve Patient Outcomes with Remote APCM Services (final CTA)

Advanced primary care management is a way for providers to support patients during, after, and between routine appointments and hospital stays. It encourages healthcare professionals to go above and beyond the bare minimum of care by offering consistent, around-the-clock care options for those living with chronic conditions.

CoachCare can help your practice deliver APCM services with remote patient monitoring technology. Bridge the gap between your office and the outside world with solutions that provide real-time insights into your patients’ needs.

Discover more ways to support your patients—explore CoachCare’s RPM devices, and book a demo today to see our platform in action.