Advanced Primary Care Management (APCM) is Medicare’s newest program, introduced in 2025 with three billing codes: G0556, G0557, and G0558. This represents a pivotal shift toward value-based primary care by offering monthly reimbursements for delivering continuous, patient-focused services. You're already providing these services—why not get paid for it?
So, what do you need if you're going to implement APCM?
1. 24/7 Clinician Access
Patients enrolled in APCM must have the ability to reach a clinician at any time, day or night. In practice, this typically involves setting up an on-call rotation among your staff or contracting with a dedicated nurse triage service. Whoever answers the call should have secure, real-time access to patient charts, ensuring accurate decision-making and compliance with documentation requirements.
2. Consistent Care Provider
Continuity is key in APCM—patients should consistently see the same provider or care team member. You’ll need to assign each patient a designated clinician or care team, adjusting your scheduling and routing processes so follow-up visits and communications are consistent and personalized.
3. Flexible Care Delivery
Care delivery under APCM extends beyond traditional office visits. Your practice will need to offer telehealth visits (both video and phone), portal-based e-visits, and even accommodate extended hours or home visits when appropriate. These options help ensure patient needs are met conveniently and effectively.
4. Comprehensive Care Management
APCM requires a broader view of care management, addressing not only medical needs but also psychosocial and functional health concerns. Your practice should implement structured intake procedures, regular medication reconciliations, preventive health checks, and proactive monitoring of high-risk patients.
5. Electronic, Patient-Centered Care Plan
Every patient enrolled in APCM must have a dynamic, electronic care plan accessible to the patient, their caregivers, and the clinical team. This plan should be regularly updated, especially after significant health changes like new diagnoses, medications adjustments, or hospitalizations.
6. Timely Follow-Up After Care Transitions
Patients discharged from hospitals, emergency rooms, or skilled nursing facilities must receive follow-up contact within seven days. Implementing processes to capture admission and discharge notifications and assigning staff to promptly follow up are critical for compliance and continuity.
7. Coordinated Practitioner and Community Support
Primary care under APCM involves close coordination with specialists, home health services, and local community resources. Your practice should maintain a reliable referral tracking system, securely store consult notes, and build and regularly update a directory of community-based support services.
8. Enhanced Patient Communication
Patients should be able to communicate with their care team asynchronously via secure messaging or patient portals. Establishing protocols to ensure staff respond promptly—typically within one to two business days—helps maintain patient engagement and satisfaction.
9. Documented Patient Consent
Before enrolling a patient in APCM, informed consent must be clearly documented. Patients need to understand billing exclusivity, their right to discontinue services, and potential cost-sharing responsibilities. Creating and using standardized scripts and consent forms will simplify this process and ensure compliance.
10. Required Initiating Visit
New patients or those who haven't been seen in over three years require an initiating visit to begin APCM services, often conducted as an Annual Wellness Visit or comprehensive evaluation. During this visit, your team should review health conditions, set initial care goals, and capture consent documentation thoroughly.
11. Population-Level Data Analysis
Practices implementing APCM must proactively analyze their patient panels to identify and address gaps in care. Utilizing population health dashboards can help your team efficiently identify patients needing screenings, lab tests, or follow-up visits and assign outreach tasks accordingly.
12. Risk-Based Patient Stratification
CMS expects practices to categorize patients into low, medium, and high-risk groups. This stratification should be based on factors such as chronic conditions, recent hospitalizations, emergency visits, and social determinants of health. High-risk patients, in particular, will require more frequent contact and intensive management.
13. Quality Performance Measurement
Practices are required to regularly measure and report on specific quality metrics, such as blood pressure and A1c control, through MIPS Value Pathways or an ACO. Ensuring your electronic health record system can capture these metrics and produce accurate, audit-ready reports is crucial for meeting reporting obligations.
How FairPath Can Help
FairPath simplifies implementing APCM by embedding these requirements into your daily workflow. From managing care plans, facilitating seamless patient communications, and ensuring compliance with quality reporting, FairPath provides the tools necessary for successful APCM implementation. We’re excited to support practices transitioning to this new care model, making high-quality, proactive patient care achievable and financially sustainable.