Advanced Primary Care Management (APCM): A Guide for Patients

What is Advanced Primary Care Management (APCM)?

Advanced Primary Care Management (APCM) is a patient-centered approach that allows us, as your primary care providers, to receive reimbursement for delivering the coordinated, comprehensive, and personalized care you expect and deserve.

Medicare Expanded Covered Services under APCM– Effective January 2025,

They will now reimburse your primary care provider for:

• 24/7 access to your care team or provider through phone, text, web portal, and virtual check-ins
• Chronic care management provided by our team of three nurses that have over 50 years combined experience
• Transitional care between health care settings (like follow-up care after you’re discharged from a hospital) coordinated by our registered nurse
• A personalized care plan that lists your current conditions and treatments
• Care coordination between specialists, home health, physical and occupational therapy

*Many of the Medicare Advantage plans are following

Patients who have already enrolled in APCM will be able to text message their care coordinators in addition to regular telephone communication. Many find this a more convenient way to communicate. To enroll for this service, follow this link – ENROLL FOR TEXT MESSAGING

Why Are These Changes Happening?

• Before January 1, 2025, Medicare did not provide reimbursement for many of these services.
• The cost of delivering these services has increased significantly.
• Adjusted for inflation, Medicare payments to physicians have declined by 33% since 2001.
• Lower reimbursement rates have caused many physicians nationwide to either reduce or discontinue treating Medicare patients.
• Recognizing the importance of primary care services, The Centers for Medicare & Medicaid Services (CMS) revised Medicare coverage to ensure payment for these essential services with APCM.

Frequently Asked Questions

Will these changes result in higher costs for me?

APCM is designed to reduce overall healthcare expenses.

Traditional Medicare: At the start of every year, Medicare patients have a deductible to meet. Once this has been met, all services provided by physician offices are paid for based on the Medicare part B rules. For APCM, Traditional Medicare will cover 80% and the copay will depend on your secondary insurance. This will range from no copay to a maximum monthly copay of $10.

Medicare Advantage plans: Have not published their specifics regarding coverage. Most are covering the cost after the deductible has been met, but the copay amount varies. This depends on your individual plan and how they assess copays. Your insurance carrier should be able to answer this for you.

What if I do not want to sign up for or later decide to stop these services?

APCM participation is voluntary. You have the right to stop the billing for these services at any time effective at the end of the calendar month.

https://www.medicare.gov/coverage/advanced-primary-care-management-services

To take the next step and get started with APCM – CLICK HERE TO ENROLL

If you have any additional questions, please contact the office so that we can answer them in more detail.