Advanced Primary Care Management (APCM) is a CMS initiative effective from January 1, 2025, aimed at strengthening primary care services. It consolidates Chronic Care Management (CCM), Principal Care Management (PCM), Transitional Care Management (TCM), and other communication-based services into a unified, non-time-based billing structure.
“Our primary goal is to reduce administrative burdens and promotes comprehensive patient care."
Patients must give documented consent to enroll in APCM and also consent to cost-sharing. They must undergo an initial visit if they haven’t seen a provider in last 3 years.
Care coordinators work with patients to create, implement, and manage an effective care plan and oversee the patient’s transition from one healthcare setting to another.
Practices must examine patient population data to detect care gaps and risk-stratify their patients using three levels, GPCM1 (Level 1), GPCM2 (Level 2), and GPCM3 (Level 3).
Seamlessly combines CCM, PCM, and TCM into a single workflow and utilize artificial intelligence to identify at-risk patients.
Streamline billing with automated generation of documentation for reimbursement and supports the latest APCM billing codes.
Boost patient engagement and medication adherence with cutting-edge remote assessments and medication adherence programs.
With care coordination support and round the clock care accessibility, providers can deliver 24/7 care to their patients.
HealthArc is focused on bridging the patient-provider communication gaps by engaging patients via SMS, email, video and phone calls.
Every patient is unique and so needs to be their care plans. We help formulate individualized care plans accessible to patients and their families.
Our platform supports personalized care plans, proactive patient engagement, and continuous monitoring — whether or not devices are used. Advanced Care Management can be effectively combined with Chronic Care Management (CCM), Principal Care Management (PCM), and Remote Therapeutic Monitoring (RTM), creating a holistic approach to improving patient outcomes.
With a strong focus on data-driven insights and workflow automation, HealthArc empowers providers to deliver high-quality care while optimizing resources and reducing overall healthcare costs.
Through real-time data insights, risk stratification, and coordinated interventions, HealthArc's APCM services enable providers to take the lead in improving patient care. The platform provides a centralized communication and care plan that fosters timely follow-up visits, medication adherence, and preventive screens; benefiting clinical outcomes and reducing hospitalizations.
Designed to assist practices in maximizing reimbursement opportunities through CMS and commercial payers, HealthArc offers automated documentation that tracks compliance and optimizes CPT code use to bill more efficiently and accurately. Thus, providers are enabled to monetize Chronic Care Management (CCM), Principal Care Management (PCM), and Remote Therapeutic Monitoring (RTM) from one interface.
Decrease administrative burdens through HealthArc's intelligent task management and automation of workflows; with integrated EHR interoperability, AI-driven alerts, and customizable care protocols that promote clinical workflow so more time is spent with patients than on paperwork. Our platform allows efficient team-based care delivery through effective task delegation based on team role.
Implement HealthArc's APCM program to fit your specific practice's care model, staff structure, and patient population. Whether you are managing typical small panels or large populations, this will work for you and your patients.
The training covers comprehensive onboarding and role specific training so that your employees are comfortable using the platform. Your staff will also continue to receive support and education for keeping abreast of ongoing changes.
As soon as you go live, you can immediately start providing enhanced, coordinated care. HealthArc continues to offer proactive technical and clinical support for your success and optimizing performance over time on the platform.
Our Advanced Primary Care Management (APCM) services are designed to complement Remote Patient Monitoring (RPM) and other digital health programs. This allows providers to offer a truly integrated and connected remote care experience that combines continuous physiological monitoring, real-time virtual consultations, and structured care management into a unified workflow.
The APCM platform has been built with compliance at its core to support providers in complying with the latest CMS guidelines and regulatory updates. From automatic time tracking and digital consent documentation to audit-ready reporting, the platform simplifies the complexities of managing regulatory requirements across multiple care management programs.
Find out how HealthArc’s Advanced Primary Care Management (APCM) platform improves how you provide care. Create efficient workflows, maximize reimbursement, and transform outcomes-all from a single, powerful, and unified platform.
These HCPCS codes correspond to the monthly chronic care management payments depending on the number of chronic conditions and patient eligibility:
CCM codes are CPT based and require the tracking of time (e.g., 20+ minutes/month), while APCM codes provide a flat monthly rate based on risk tier and do not require time documentation. They simplify billing for practices working under value-based care frameworks for Medicare patients.
The patient must have had a visit with the billing provider in person to bill any of the APCM codes according to the following:
A QMB is a low-income Medicare beneficiary who is enrolled in both Medicare and Medicaid. These patients are completely protected from balance billing, and provide G0558 offers increased reimbursement due to their complexity and care needs.
They are assigned based on:
Many practices use an EHR-algorithm or population health tool to stratify patients accordingly, whereas documentation needs to support chronic diagnoses with an ICD-10 code.
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