Built for APCM
Advanced Primary Care Management pays a monthly fee for care you already deliver. BillDocAi is the system of record that makes sure none of it slips: who is eligible, who consented, what was billed, what was collected, and what month you missed.
Three codes, one per enrolled patient per calendar month. Which one applies depends on the patient's chronic conditions and QMB status.
CMS published rates. Actual reimbursement varies by locality.
APCM pays per enrolled patient per calendar month. The revenue is recurring and predictable, and it comes from patients already on your panel.
One code per enrolled patient, every month, whether or not they came in. Revenue that does not depend on filling the schedule.
Unlike CCM, APCM has no time requirement to hit or document. You record the care you delivered, not a stopwatch reading.
Eligibility rests on being the patient's primary care medical home — which for most of your Medicare patients you already are.
Every enrollment adds to a monthly base that carries forward. A hundred patients on G0557 is roughly sixty thousand dollars a year.
The economics of APCM are simple. The administration is not — which is where most programs quietly lose money.
Import your attributed Medicare panel and identify candidates. Attribution and enrollment are tracked separately, because a patient can be one without the other.
Verbal or written, recorded with a date and the signed form or call note attached. Consent is what makes the claim defensible, so nothing bills without it.
Med reviews, care-plan updates, specialist coordination. The service date is derived from the care you logged.
One click generates a row per enrolled patient, blocks anyone who cannot be billed, and tells you why. You submit in your EHR and mark them billed.
Charged against collected, by month. Any closed month still unbilled is flagged as overdue — that is revenue earned and never claimed.
A blocked row costs a conversation. A denial costs a recoupment.
We are not a billing suite that added an APCM tab. The product was built inside a primary care practice to run its own Medicare panel, and it is used that way every day.
Every rule in the software exists because it was needed: the CCM overlap block, the consent gate, the calendar-month logic, the overdue alerts. None of it is theoretical.
Consent documents stored against the enrollment, a per-user accountability trail, and a reconciliation view that ties what you charged to what arrived.
The software blocks a claim rather than letting it through — CCM in the same month, consent missing, a G0558 without verified QMB. A denial is more expensive than a warning.
BillDocAi does not transmit claims. You bill in your EHR; this keeps the record, catches what slips, and tells you what is owed.
The program is the same. What it takes to run well is not.
Most independent practices are eligible for far more APCM revenue than they capture, and the gap is almost always administrative rather than clinical.
Read moreAt multi-site scale the questions change. Not whether APCM is worth running, but whether it is being run consistently, and whether you could prove it.
Read moreIf you already deliver billing or care management, APCM is an adjacent line you can offer without adding clinical staff. The administration is the product, and it is the part you would otherwise have to build.
Read moreTell us your rough Medicare panel size and how you run care coordination today. We will come back with what the program would look like for you.
Request a proposalNo public price list, and no self-service signup. Every account is set up with a Business Associate Agreement in place first.