Advanced Primary Care Management

Table of Contents:

• Eligibility Rules
• CPT Rates
• Consent
• Add Care Plan
• Manage Care Plan
• Clinical Time Logging
• Approve Time

Eligibility Rules:

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• There should be no active CCM service.
• There should be no active PCM service
• And, should have an active Medicare insurance.

CPT Rates:

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1. There are six CPT codes for APCM.
2. Below are the details of these CPT codes with their rates.

Instructions:

1. To add APCM, go to Patient Dashboard. Click on APCM tab. Click on "Add Care Plan" Button. Consent screen appears.

Consent:

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Important:

1. In the APCM, we can migrate the CCM care plan if the CCM care plan exists for that particular patient.
2. If the patient has a CCM care plan, a checkbox will be shown below the patient details. If there is no checkbox, then consider that there is no CCM care plan exists.
3. We can't migrate the CCM care plan once the APCM care plan is submitted.
4. If you have not submitted the APCM care plan and you want to migrate the CCM care plan, you should discontinue the service and then resume it.
5. While resuming the service in the APCM, consent to check the "migrate CCM care plan" checkbox, accept the consent, and click submit. Then the completed CCM care plan data will be autofilled.

Note: If you choose to migrate the CCM care plan in APCM, then whatever data you have filled will be autofilled, and the rest of the required fields should be filled manually in order to submit the care plan.

1. If the patient agrees to take APCM service, click on "Accepted by patient". If the "Migrate CCM care plan" checkbox is visible, then choose the best way that suits your process and click submit.

1. You can view the Consent in two languages - English and Spanish. By default, we have English language selected.
2. There is an option available to upload a file in the content, which is not mandatory.
3. Above the consent tab, you can access a clinical time clock where you can view the clinical time and generate a bill.
4. You can select the Spanish Language to view the Consent in Spanish as follows:

1. If the patient disagrees, then click on "Rejected by patient" and submit.

1. You can view an Edit button at the right, you can edit and select "Accepted by patient" option, when the patient wants to take the service.

Add Care Plan:

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1. After submitting consent, you'll see the Care Plan screen (Only when the Consent is accepted by the Patient).

1. You will see a wizard at the top, with the following sections:

• Risk Stratification
• Diagnosis
• Medications
• Care Questionnaire
• Important APCM Information
• Other Details
• Notes

1. In the first section, we have Risk Stratification. This is a mandatory section, and we need to select any one option. Upon selecting the option, we will see an intervention text box below the option, which is not mandatory.

2. Once you have answered the Risk Stratification section, click on Save & Continue Button, it redirects to Diagnosis section.
3. In the Diagnosis section, we have fields - Chronic conditions, Allergy. To add data, you can see an add button beside their labels. On clicking the button, respective pop-up appears.
4. Search the condition on clicking the Search button and Fill the other details and click on Add button in Chronic Care Problem, Surgeries and Test/Procedures Pop-ups.

5. To edit the data, hover on the input field to see Edit and Delete options. On clicking Edit button, respective pop-up appears, make changes you want to update and click on the Update Button. Once you have updated Diagnosis, click on Save & Continue Button, it redirects to Medications section.

6. You can see thee list of Active Medications prescribed for the patient. You can add, edit, activate & inactivate, and delete medicines.

7. To add medicines, click on "Add Medicine" Button on the right. Add Medication Pop-up appears. To get prescription expiry reminder, check the box and select any of the two options - Remind before 5 days or 10 days and click on "Add Prescription" Button to save and add Prescription.

8. To edit any medicine, click on the respective Edit buttons. Upon clicking Edit button, Update Prescription pop-up appears, make the changes you want to update and click on Update Button.
9. To inactivate any medicine, switch the toggle to OFF state, the medicine will be inactivated. Switch the toggle to ON state, to activate the medicine back.
10. Click on Next Button, once you made your changes in Medications Section. Care Questionnaire section appears.

11. Within this section, you will find all the questions. This section is not mandatory to add to the care plan, but you have to answer the goals questions in order to enable the goals section.
12. on click on the accordion the you see that section questions.

• After answering the question, please click on the "Save Changes" button to save the section.
• After saving, the section will be disabled. If you want to make changes, click on the edit button.

13. After answering all the required questions in the care questionnaire, click on the "Save & Continue" button. The "Important APCM Information" section will appear.
14. In this section, all the questions are mandatory to answer. Without answering all the questions, you cannot submit the care plan.

16. After answering all the required questions in the care questionnaire, click on the "Save & Continue" button. The "Other Details" section will appear.
17. In this section, not all the questions are mandatory to answer. You can submit the care plan without answering all the questions, but we recommend filling in the required fields.

18. After answering the questions, click on the "Save & Continue" button. You will be directed to the Miscellaneous section.

• Important Note: If we have migrated the care plan, then before submitting the Add Care Plan, we have to check the checkbox for review. Without checking the checkbox, we cannot add the care plan, and the "Add Care Plan" button will be disabled.

19. After adding the notes, Now, please click on the "Add Care Plan" button to successfully add the care plan.

Following up the Care Plan, you have Goals section as shown below.

1. In the Goals section we can will have three section which is List of Goals, List of Options and comments.

2. In the list of goals, we will find all the goal questions that are included in the care plan. In the list of options, we will find the options that we have selected for each question, and the comment is where you can leave your comment.

3. After adding the comment, click on the "Add" button to save the comment. The comment will be saved, and you can see it in the history.

Important Note: If you have migrated the care plan, then the CCM care plan goals will be migrated with the respective added comments for the goals.

4. Once you save it, it changes to edit mode where the field will be disabled. If you want to add new or edit, click on the "add" based on the requirements. You can also see the history when you click on the "history", where you can view, edit, and delete the comments.

• Following up the Goals, you have Assessment section as shown below.

1. In the Assessment section, we have two sections FRA and HRA.

2. To add FRA, click on the +Add New button. Upon clicking on it, you will see the list of questions, and at least one should be answered in order to submit the form. Once the form is submitted, you will be able to see the added history under the history section.

3. Once added, you can see the FRA in the history section. Upon hovering on the title, you can see the edit and delete icons, and from there you can perform the actions.

4. When the FRA is added, it will also add notes in the notes section with points (which are based on the answers you have given), and a non-billable record will be added based on the FRA time. The FRA will be attached to it.

• The same goes with HRA but the only difference is you will not get the points in the notes for HRA.

  Important Note: If you have migrated the care plan, then the CCM care plan Assessment will be migrated.

  

  

  
  

• Following up the Assessments , you have Activity section as shown below.

1. To add an Activity, click on the "New Activity" Button on the top-right. Add Activity Pop-up appears. Billing Type, Provider, patient and Date fields will be auto-populated. Fill the other details and click on the "Add" Button.

1. Added Activity will get saved as follows.

Manage Care Plan:

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1. Upon adding the care plan, you will observe an upload button allowing you to upload a file. Please ensure that the file size does not exceed 5 MB.
2. Now you will find two buttons located on the right end: View Log History and View Summary below the wizard.
3. Once the Care Plan has been added, you have the ability to edit and modify any field in any section.
4. Within the view log history section, you have the ability to access detailed logs of all activities. This includes updates or modifications made by program coordinators/providers, with each log displaying relevant information such as names, dates, and timestamps. By interacting with the designated button, a pop-up window will appear, allowing you to conveniently review the logs and download them in A4 format.

8.2 In the Summary view, you will find a comprehensive overview of the APCM service, including 'From' and 'To' details. Additionally, there is an option available to download the summary.

• In the Risk Stratification section, you will find a button to edit the section.

• In the Diagnosis section, you will have an icon to edit, and delete chronic conditions and allergies.

1. To edit Diagnosis list, hover over the fields, you can see an Edit icon, shown as follows. Once you make the changes, click on the Update button to save the changes. Else click on Cancel button to discard the changes.
2. On clicking the Edit icon, to make an updates in the Conditions, then click on the Search Button to check other conditions and after you make changes then click on the Update Button.
3. Similarly, to make any changes in Allergies, click on the Edit icon and Update button to save the changes.
4. You can also view Delete icon, on clicking it you will be asked to confirm if you want to proceed and delete.
5. You cannot update the Condition, only Condition details, you can go back and add a new condition by clicking on the + icon.

6. In Medications, click on the Edit icon in the Actions, to edit the medication.

7. You will see the pop-up as shown below. Click on the Update button once you make your changes.

8. In care questionnaire, you can see an Edit button at the right, to make the edits.

9. Click on the Edit button, you will see the screen as follows, after you make your changes click on the Save Changes Button.

10. In important APCM information details section, click on the Edit button to make the changes.

11. In other details section, click on the Edit button to make the changes.

12. Make your changes and click on the Update Button. Else click on the Cancel Button. It will ask for a confirmation, if you want to discard the changes.

13. Activity can be added, cannot be edited/ deleted.

APCM History:

Upon clicking on the APCM history, you will see a small pop-up model opening next to the button. Here, you can view the care plan enrolment history.

If you want to discontinue the service, click on the "Discontinue APCM" button located next to the service history. Upon clicking on the "Discontinue" button, you will encounter a pop-up modal where you will be required to provide the reason for discontinuing the care plan.

Currently, the APCM functionality is disabled, preventing any actions such as adding, editing, or deleting entries within the care plan. However, you still have the ability to download view summary reports.

If you want to resume the service then click on the "Resume Service" button at the top. Upon clicking on it, you will be redirected to a new consent page where, upon accepting the content, the entire care plan will be enabled, and the enrolment date will be recorded in the APCM history.

From clinical time, you can manually add the bill by clicking on the add icon.

Important Note: APCM is not time based. the bill be generated monthly once so.

• Service - The service will be auto-populated as apcm.
• Activity - Activity will be auto-populated as billing.
• Date - Select to which date you would like to be billed.
• From - select the from time.
• To - select the to time.
• Notes - Add a note that is related to the billing.

When adding the record, it will be saved in the clinical time section.

There are multiple ways to add a bill.

1. From Patient Listing.
2. From Patient Dashboard.

3. Manual Log Entry From Clinical Time.

   
   

1.From Patient Listing.

As shown in the above image, when you click on any service APCM in the patient listing, it will show you the pop-up as follows.

If you click on Yes, the timer will start (billing time will begin) and you will navigate to that service in the patient dashboard. If you click No, you will navigate to that particular service in the dashboard without billing.

Billing Flow

• If you have clicked on the APCM service and then clicked on Yes to bill the time, it will navigate you to the service with the billing timer ON. This action will disable other services because when you are billing for a particular service, you can't navigate to other services such as PCM, TCM, RPM, or AWV.

  

• If you want to stop the billing, you can click on the STOP icon at the top near the header as follows.
• Once you STOP the billing, the other services will be enabled, and the bill will be reflected in the clinical time billing activity section.

2. From Service:

If you wish to initiate the billing process while navigating a specific APCM service tab, you can seamlessly commence billing by selecting the Start Billing icon located at the top and proceeding with the instructions outlined in the Billing flow.

• If you want to bill the records that are in the Billing section, then click the checkbox at the beginning of each record.

• You can see an "Add Bill" button on the Top Right of the table. Click on it to show a pop-up for adding a bill as follows.

• Service - The service name will be pre-populated based on the record you selected in billings.

  Note: If you select multiple records with different services, then it will be categorised as "others."

• CPT code: - Select the CPT code based on the billing type.

• Description - Based on the CPT code, you will receive some descriptors from which you can select.

  Note: If the desired descriptor is not available, scroll to the bottom of the dropdown, click on the other option, and enter your desired descriptor.

• Provider - The provider's name will be pre-populated based on the record you selected in billings.
• Patient - The patient's name will be pre-populated based on the record you selected in billings.
• From Date - It will be pre-populated, and the date and time will be based on the oldest record selected.
• To Date - It will be pre-populated, and the date and time will be based on the newest record selected.
• Notes - Add a note that is related to the billing.

• Call Type - It will be pre-populated when you select the CPT code. It is also editable.

  After clicking on Add, the billed records will be disabled. The bill will reflect in the Claims tab.

To submit the bill, click on the Bills Tab to navigate to the Bills section.

• Upon navigating to the Bills tab, select the service type in which you have added the bill from clinical time.

  Note :- If you have added a bill with services other than clinical time, please select the 'Others' tab in the service section of the billing.

3. Clinical Time Logging:

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1. To view the Clinical Time Logging (Billing) for APCM, go to the Patient Dashboard and click on the Claims Tab. Following screen can be viewed.
2. There are sub tabs - APCM, TCM, CCM, RPM , RTM etc.. billing logs for each program.

1. Clicking on APCM, RPM, CCM, TCM and Others tab, will display calls list with checkboxes for each row with details as follows:

• CPT code
• Description
• Status
• Action

1. CPT codes are different for all types i.e., APCM, RPM, CCM, TCM and Others. CPT codes for all reimbursement types are different.
2. Billing Period- From and To date range can be selected in the Billing period to display the calls between the selected range.
3. Click on APCM tab.

1. User can use the Add Row option to add a row in the given list with entering the details like Billing Type, CPT code, topic, Provider, Patient, Date, Start Time, End time, Meeting Notes and call type.

1. To edit the call details click on the Edit icon in Action, allows user to edit the details like Billing type, CPT code, topic, Date, Provider, Meeting Notes, call type for selected row in the list.

1. User can select the record from the list and click on Submit.

1. The submitted bills cannot be edited.

1. Each reimbursement type tab have filters as shown:

• All - Shows all the APCM call logs
• New - Displays all the newly submitted calls/ bills and are represented by Blue Color
• Submitted - Displays all the submitted calls/ bills and are represented by Light Green Color
• Rejected - Displays all the rejected calls and are represented by Red color
• On-Hold - Displays the calls which are kept on-hold and are represented by Amber Color
• Approved - Displays all the approved calls and are represented by Green color

1. You can view 2 actions in the Action - Edit and Delete. All New/ Rejected bills will have these icons enabled.
2. Once the Bill is submitted/ kept on-hold and Approved, these icons will be disabled.
3. On clicking the Rejected calls/bills, User can view the Rejected reasons, which shows the date with rejected reason.

1. Upon clicking the download icon, you will be able to access the Summary of the APCM Episode. Additionally, you can download it by clicking on the floating download button or use the print button to print the PDF.

• we can also download the bulk bill document by clicking on the Download Supporting Documents Button

Approve Time:

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1. The calls logs that are being submitted are saved in the Billing Portal. When the Admin logs in he can view the following screen.
2. By default, we have All Programs and All Providers selected. You can change it based on your preferences.

1. On the dashboard, count for Patients enrolled, Patients billed, Bills accepted, Bills pending will be displayed.

2. On the left-hand side, there is a table icon. Upon clicking on it, a pop-up will appear where you can select the required table columns, as shown below.

   

   

3. There are 5 filters - Status, Program, and Provider, Duration and Search Bills, using which we can search the bills to review.
4. User can filter the submitted billing list based on the Status of the bill in 4 categories.

• Submitted Bills
• Bills on Hold
• Accepted bills
• Rejected bills

1. Patients which are qualified by rules engine for the set of rules mentioned for respective CPT code, will be ready to Bill and patients which do not qualify the set of rules mentioned are rejected by rules engine.
2. User can filter the submitted billing list based on the type of billing or product (All/RPM/CCM/RTM/TCM/APCM/PMPM)
3. Click on the Status filter and select Submitted Bill option and Program filter and select APCM . The following screen can be seen.

1. User can filter the submitted billing list based on the selected duration of Date from and Date to. We can view the bills based on the Duration type - Monthly or Quarterly, by default, we have Monthly selected.

1. User can filter the submitted billing list based on the provider name for the specific center.
2. Search field will be available to search the required data on the dashboard.
3. Below the filters, we can see the table with following headers:

• Checkbox - To select all the records
• Patient EMR ID
• Patient Name
• Date of Service ( Date on which the service was provided)
• CPT Type (APCM/RPM/CCM/TCM/Others CPT code and Topic)
• Note (Meeting Notes while scheduling)
• Provider Name
• Bill details (Bill ID and Month Date, Year on which billing was submitted )
• Actions (Approve /On Hold /Reject)

1. All the submitted bills in the list, in the checkbox form, user can select the bulk actions to mark the selected bills as Approved or Rejected. And also can download the bills by clicking on the Download option.
2. Click on the checkbox and click on the Accept selected bills at the right, to submit the bills. You will view a pop-up to confirm if you want to accept the bill or not. Click on Yes to accept the bill.

3. We can also reject bulk bills by selecting the records and clicking on the "Reject selected claims" button, which will be visible in the headers once you select the bills. Upon clicking the button, a pop-up will appear where you have to enter the reason for rejecting the bills and click submit. The bills will then be seen under rejected bills.

   

4. You can perform actions - Approve, On Hold and Reject for individual calls. After the call log is being Approved/ is On Hold / Rejected. Those call logs will be categorised into Accepted/Rejected/On Hold respectively.

1. If there are no calls logs, you will see an empty state showing No records found.

1. After the bills are accepted, we can view them by selecting the Status as Accepted.
2. Here, to download the Bill report, check the box for an individual record or check the box in the header to download report for all the reports.
3. We can download the report w.r.t any Status - All, Ready to bill, Submitted, On-Hold, Rejected and Approved.

1. You can view download option at the right, click on the download to download the report. You can view it in your downloads.

2. We can also add the Billed Amount, Allowed Amount, Adjusted Amount, Balance Amount for each bill in the input field where you can enter the amount and click outside the field. It will be saved, but it is only for reference and will not be referenced anywhere else.

   

3. We also have the options of Claim Denied, Claim Failed, Closed, Patient Pending, Secondary Pending, and Claims On Hold to change the payment status of each claim. To access these options, select the submitted claim status and click on the more icon as shown in the below image.

   

   
   

4. We also have the option to upload the billing reconciliation file. You can upload an Excel file with the claims data of each patient and check the history of the uploaded file. Additionally, you can download a sample file or sample reconciliation template by clicking on the "Download Reconciliation Template" button.

   

   

Note:

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