FairPath Lets You Run Your Own APCM Program with Confidence

The Implementation Barrier

Why 87% of PrimaryCare Practices Haven't Implemented APCM

Medicare's Advanced Primary Care Management promises substantial revenue opportunities, but implementation barriers prevent most practices from participating:

Overwhelming Documentation Requirements

APCM demands comprehensive documentation across 13 distinct service elements, including care plan management, 24/7 access logs, interdisciplinary team coordination, and patient engagement tracking. Unlike existing care management codes, APCM eliminates time-based thresholds but introduces new documentation challenges that most EHRs cannot fully support.

Complex Service Element Management

Practices must maintain capability to provide all 13 APCM service elements including 24/7 access, comprehensive care plans, systematic needs assessments, medication reconciliation, and care coordination, even when not all elements are used each month. This "availability requirement" creates operational complexity that overwhelms under-resourced practices.

CEHRT Integration Challenges

APCM requires care plans to be recorded in Certified Electronic Health Record Technology (CEHRT) with real-time access for the entire care team. Most existing EHR systems lack integrated workflows for APCM's comprehensive requirements, forcing practices to manage documentation across multiple platforms.

Concurrent Billing Restrictions

APCM cannot be billed concurrently with CCM, PCM, TCM, or 15 communication-based technology CPT codes, requiring practices to strategically choose between programs while ensuring no revenue loss during transitions.

MIPS Reporting Requirements

MIPS-eligible practitioners must report through the Value in Primary Care MVP beginning in 2026 for CY 2025 performance, adding another layer of complexity that many practices are unprepared to handle.

No Headaches, Just Results

FairPath: Software Stack for Small to Mid-Sized Practices

Built for teams with no time to waste.
‍
FairPath is a hassle-free software stack that helps smaller practices run RPM, RTM, CCM, and APCM without hiring extra staff.

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Compliance First

Run your entire remote care program with the full stack of software solutions that ensure you remain compliant while providing care.

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Scalable Technology

Handles thousands of patients across multiple conditions.

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Proven Foundation

Built on a 98% success rate and active CMS compliance monitoring.

FairPath Pro: Turnkey Solutions for Larger Partners

FairPath Pro provides larger operations with the level of customization and integration they need to run effective and compliant remote care programs for large patient populations.

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Full-Service Billing

From eligibility checks to ICD-10 coding to claim tracking, we handle it all.

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Affordable Access

No upfront integration fees. Just results.

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Proven Expertise

1.1 million+ transactions processed. $36.7M paid to real practices.

Medicare's Revolutionary Primary Care Program

Understanding APCM

Advanced Primary Care Management represents CMS's most ambitious primary care initiative, designed to transform how practices deliver comprehensive, coordinated care while providing sustainable reimbursement.

Universal Eligibility: Every Medicare Patient Qualifies

Unlike previous care management programs limited to patients with multiple chronic conditions, APCM expands eligibility to all Medicare Part B beneficiaries, including patients with zero, one, or multiple chronic conditions. This universal approach enables practices to manage their entire Medicare population under a single, comprehensive program.

Eligible Populations Include:

Medicare Part B beneficiaries with no chronic conditions
Patients with single chronic conditions
Complex patients with multiple chronic conditions
Dual eligibles, including Qualified Medicare Beneficiaries (QMBs)

Three-Tiered Revenue Structure

APCM uses a risk-stratified payment model that rewards practices for managing increasingly complex patients:

Level 1 (G0556): $15.20 per patient per month for Medicare beneficiaries with one or fewer chronic conditions
Level 2 (G0557): $48.84 per patient per month for patients with two or more chronic conditions expected to last at least 12 months
Level 3 (G0558): $107.07 per patient per month for patients with multiple chronic conditions who are Qualified Medicare Beneficiaries

Billing Structure

APCM eliminates time-based documentation requirements that burden CCM and PCM programs, instead focusing on service availability and patient outcomes. Practices bill once per patient per month regardless of actual time spent, dramatically reducing administrative burden while ensuring comprehensive care.

Key Differentiators from Existing Programs

Versus Chronic Care Management (CCM):

APCM covers all Medicare patients vs. CCM's chronic condition requirement
No minimum time thresholds vs. CCM's 20-minute monthly requirement
Bundled service approach vs. individual service billing
Outcome-focused vs. time-focused documentation

Versus Principal Care Management (PCM):

Multi-condition coverage vs. PCM's single serious condition focus
Simplified billing structure vs. complex time tracking
Integrated care coordination vs. disease-specific management

Versus Transitional Care Management (TCM):

Ongoing monthly support vs. TCM's post-discharge limitation
Preventive focus vs. reactive post-acute care
Population-level management vs. episode-specific intervention

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Mastering APCM

APCM's 13 Critical Service Elements

APCM requires practices to make 13 distinct service elements available to patients, though not all elements must be provided each month. Understanding and implementing these elements is crucial for compliance and optimal patient outcomes.

Core Foundation Elements

Patient Consent & Documentation
‍Documented consent must be obtained before starting APCM services and can be written or verbal but must be documented in the medical record. Patients must understand they can stop services anytime and that cost-sharing may apply.
Initiating Visit Requirements
‍New patients or those not seen in the previous three years require an initiating visit, paid separately. Medicare Annual Wellness Visits may qualify if performed by the APCM-responsible provider.
24/7 Access & Continuity
‍Patients must have 24/7 access to care team members for urgent needs, with real-time access to medical information and ability to schedule routine appointments.

Care Management Elements

Comprehensive Care Planning
‍Electronic patient-centered care plans must be developed, implemented, and maintained in CEHRT systems, accessible to patients and the entire care team.
Systematic Needs Assessment
‍Regular medical, functional, and psychosocial assessments to identify care gaps and intervention opportunities.
Medication Management
‍Comprehensive medication reconciliation, adherence monitoring, and oversight of patient self-management.
Preventive Care Coordination
‍Systematic approaches to ensure receipt of preventive services and evidence-based care protocols.
Care Coordination
‍Management of referrals, specialist care, and coordination with home- and community-based providers.

Advanced Service Elements

Population Health Management
‍Risk stratification of practice populations based on defined diagnoses, claims, or electronic data to identify and target services.
Quality Measurement
‍Performance measurement and reporting including assessment of primary care quality, total cost of care, and meaningful use of CEHRT.
Care Team Integration
‍Documentation of interdisciplinary team roles and shared responsibility in patient care management.
Communication Technology
‍Integration of telehealth, virtual check-ins, remote evaluations, and digital communication tools.
Outcome Tracking
‍Continuous monitoring of patient progress, health outcomes, and care plan effectiveness.

Smart Claims Coding system automatically identifies optimal billing strategies, preventing concurrent billing conflicts while maximizing revenue. Our AI analyzes patient service history to recommend the most appropriate care management program for each patient.

Key Features

Automated concurrent billing conflict prevention
Revenue optimization algorithms
Patient service history analysis
Billing workflow automation
Real-time claim status tracking and management

Audit-Proof APCM

Comprehensive Compliance Protection

CMS Audit Preparedness

CMS considers billing for APCM services as an attestation that the service meets all requirements specified in the code descriptor. FairPath ensures practices maintain comprehensive documentation to support every APCM claim.

Documentation Standards

Tamper-proof timestamps on all patient interactions
Complete audit trails for care plan modifications
Automated compliance checking before claim submission
Real-time alerts for missing documentation elements

Regulatory Compliance Framework

HIPAA Compliance

End-to-end encryption for all patient communications
Role-based access controls and audit logging
BAA compliance with all third-party integrations
Regular security assessments and penetration testing

Medicare Compliance

Automatic prevention of concurrent billing with CCM, PCM, TCM codes
Real-time eligibility verification and updates
Proper cost-sharing documentation and patient notification
CEHRT-compliant care plan documentation

Risk Mitigation Strategies

Pre-Submission Validation

AI-powered claim review before submission
Automated detection of potential compliance gaps
Real-time alerts for billing conflicts or missing elements
Historical pattern analysis to identify audit risks

Post-Submission Monitoring

Continuous claim status tracking
Automated denial management and appeals
Pattern recognition for emerging compliance issues
Proactive notification of regulatory changes

APCM Implementation

Your Questions Answered

Program Eligibility & Requirements

Can specialists bill APCM codes?

APCM service codes are primarily for primary care specialties like general internal medicine, family medicine, geriatric medicine, or pediatrics. Some specialists serving as primary care sources (cardiologists, OB-GYNs) may qualify.

What's the difference between APCM and CCM?

APCM covers all Medicare patients vs. CCM's chronic condition requirement, eliminates time-based documentation, and uses risk-stratified payment levels. APCM focuses on activities rather than time, with no time-based thresholds unlike CCM and PCM services.

Can we bill APCM and RPM together?

Yes, Remote Physiologic Monitoring and Remote Therapeutic Monitoring services are separately billable alongside APCM, providing additional revenue opportunities.

Implementation & Operations

How long does APCM implementation take?

FairPath implementations typically complete in 4-6 weeks, including system configuration, staff training, and patient enrollment. We provide ongoing support throughout the process.

Do we need separate consent for APCM patients?

Yes, practices must obtain separate consent for APCM services, as separate consent for CCM and APCM services is required.

What happens to our existing CCM patients?

Patients can transition from CCM to APCM, with care teams managing the entire transition process and education about enhanced services.

Billing & Compliance

When can we start billing APCM?

APCM services became available January 1, 2025. Practices can begin enrollment and billing immediately.

What documentation is required for APCM?

Documentation should adequately reflect applicable APCM services delivered during the month, including patient interactions, care plan updates, and communications with other providers.

How does MIPS reporting work with APCM?

MIPS-eligible practitioners must report through Value in Primary Care MVP starting in 2026 for CY 2025 performance. FairPath automates this reporting process.

Boosting Practice Revenue with AI Precision

Results That Deliver Financial Stability

FairPath's service-first model, powered by Intelligence Factory's AI, achieves exceptional outcomes for small practices

98%

Successful Payment Rate

Our expert team leverages FairPath's precision automation for near-perfect reimbursements

<5%

Denial Rate

Industry-leading results for RPM, RTM, and CCM, slashing the $262 billion denial burden

90%

Payments Within 30 Days

Rapid resolution accelerates cash flow from 45-60 days to under a month

FairPath Makes APCM Simple, Compliant, and Profitable

Proven Results

335K

1.1M

4+

$36.7M