Use this concise guide to identify APCM-eligible Medicare patients, obtain the required consent, and enroll them quickly with Sematic Health. It mirrors the three-step workflow—find candidates via AthenaOne, give the 30-second talk track to gather patient consent, then complete enrollment with care-plan generation.
Quick Checklist (fast path)
Identify candidate (from schedule/AWV/report).
Explain APCM to patient (≤30s talk track below).
Obtain consent (verbal/digital/written) with required elements.
Open Sematic Health → Enroll (captures consent + writes to chart).
Generate care plan in Sematic Health; assign tasks/follow-ups.
1. Identify Eligible Patients
All Medicare patients are eligible
Tier 1: 0–1 chronic disease
Tier 2: ≥2 chronic diseases
Tier 3: ≥2 chronic diseases + QMB
Build an AthenaOne APCM report
Display columns: Patient Name; Primary & Supervising Provider; Primary & Secondary Insurance Packages; Appointment Type/Date/Status; Last Seen Date; Procedure Code; Average Payment; Claim Created Date
Filters: Appointment Date Range; Appointment Type = APCM; Patient Last Seen Date Range; Primary Provider; Procedure Codes = G0556, G0557, G0558.
2. Identify APCM Initial Focus Groups
No Out-of-Pocket Expense (monthly copay or coinsurance)
Prioritize via your APCM report:
Medicare Advantage
Medicare + Supplement
Visit types & outreach
Annual Wellness Visits: discuss APCM and obtain consent during the encounter
Clinic Visits: provider/staff discuss during intake or immediately post-visit
Direct Outreach: any qualified staff may call to discuss and obtain consent
If “not now”: set a reminder and re-offer at the next AWV/visit.
3) Enrollment
Initiating Visit
Required for new patients to the clinic who will participate
Not required if seen by the billing provider/colleague within the past 3 years or participated in another clinic care-management program within the past year
Patient Consent (required prior to enrollment)
May be verbal, digital signature, or written signature. We record this for you in the patient chart in our enrollment flow.
Action in Sematic Health
Open patient in the Sematic Health Athena App or Dashboard → Enroll
Generate care plan; assign tasks/follow-ups; log activities (audit trail)
Submit a claim. You can do this anytime, once per Calendar month.
APCM Outreach Call Script
Voicemail (no answer)
“Hi [Patient First Name], this is [Your Name] from [Clinic]. I’m calling about a Medicare program called Advanced Primary Care Management (APCM) that helps us support your care between visits. No action needed now; I’ll try you again, or you can reach us at [callback #].”
Live Call
Intro & verify
“Hi, may I speak with [Patient Name]? … Hi [First Name], this is [Your Name], a [Role] with [Clinic]. Is now a good time for a quick call? For your privacy, can I confirm your date of birth?”
Purpose (≤30 seconds; key benefits)
“Medicare offers Advanced Primary Care Management (APCM) so we can better manage your chronic conditions between visits—things like cancer screenings, care-team coordination, hospital discharge and referral follow-up, and ongoing chronic disease management. We’ve long done these tasks; APCM now allows Medicare to reimburse us monthly when we follow their guidelines. We’re available 24/7, we track quality measures, and this does not replace your regular clinic visits. You’ll also receive a digital care plan with regular updates from our team.”
Costs & rights (plain-English, required elements)
“Many patients with Medicare Advantage or Medicare plus a supplement have no out-of-pocket cost; otherwise a copay or coinsurance may apply—we’ll check your benefits first. You can opt out at any time, and only one provider can manage and bill APCM for you in a calendar month.”
Enroll ask & verbal consent capture
“If you’re interested, we can start now—it takes under a minute and there’s no extra work on your part. With your permission, I’ll record your verbal consent that: we’ll provide APCM services between visits, possible cost sharing depends on your plan, you may discontinue at any time, and only one provider may bill per month. Is that okay?”
If YES: “Thank you—I’ve documented your consent. We’ll set up your digital care plan and keep you updated through the clinic. If you’re new to us or haven’t seen your provider recently, we may schedule a brief initiating visit; otherwise we’ll continue coordinating your care. Any questions today?”
If THINKING ABOUT IT: “No problem. I’ll send a brief summary to your portal (or by mail) and follow up next week. If questions come up sooner, call us at [callback #].”
Close
“We’ll coordinate next steps and keep you informed. Remember, we’re available 24/7 for urgent needs. Thank you for your time today, [First Name].”