New Medicare revenue from patients you already treat
ZenCare runs Advanced Primary Care Management inside your EHR. It tracks all 10 CMS service elements, assigns the right G-code each month and stores time-stamped evidence for every element, so you can answer an audit request in minutes.
The problem
APCM is the only new primary care revenue stream in years, but most practices never bill care management at all.
10 requirements, every patient, every month
Consent, care plans, 24/7 access, transitions, population management and more must all be in place and documented before you can bill.
No care-management team to run it
Fewer than 25,000 of about 295,000 primary care providers have ever billed CCM code 99490. Most practices have no staff to run a monthly program.
Every requirement becomes a tracked workflow
For each element, ZenCare runs the workflow and stores the evidence an auditor will ask for.
| CMS element | What ZenCare does | Audit evidence stored |
|---|---|---|
| 1. Patient consent | Scripted verbal or e-signed consent covering the one-provider rule, the right to stop and cost sharing | Signed form or call recording, date, staff ID |
| 2. Initiating visit | Flags patients not seen in 3 years or without care management in the last year, and routes the AWV as the initiating visit | Visit date and CPT/HCPCS code |
| 3. 24/7 access & continuity | ZenVoice after-hours line with escalation to the on-call clinician, plus a designated care-team member | Call logs, escalation records |
| 4. Comprehensive care management | Medical and psychosocial needs assessment, preventive gaps and med reconciliation templates | Completed assessments, reconciliation notes |
| 5. Electronic care plan | Care plan auto-drafted from chart data, signed off by the clinician and sent to the patient by portal or SMS | Plan versions, delivery receipt |
| 6. Care transitions | ADT feed alerts and 7-day post-discharge outreach tasks | Alert time, outreach time, outcome |
| 7. Home & community coordination | Referral tracking to social and home-care providers | Referral records, closed-loop status |
| 8. Enhanced communication | Secure messaging, e-visits and virtual check-ins from one inbox | Message logs |
| 9. Population management | Risk stratification and care-gap lists across the panel | Monthly stratification snapshot |
| 10. Performance reporting | Tracks Value in Primary Care MVP measures or ACO participation | MVP submission status |
Built to bill correctly, every month
Automatic level assignment
Assigns G0556, G0557 or G0558 from chronic-condition counts, with a fresh QMB status check every month.
CCM-vs-APCM conflict check
Never bills the same patient for CCM and APCM in the same month.
One-click audit binder
Exports every consent, plan version, call log and outreach record for a patient in a single file.
Auto-drafted care plans
Builds plans from problem lists, meds and recent visits. The clinician reviews and signs, and the patient gets a copy automatically.
Transitions of care
ADT alerts trigger post-discharge outreach within 7 days, tracked through to outcome.
Panel risk stratification
Gives you monthly risk tiers and care-gap lists so your team knows whom to call first.
From panel export to first APCM claim
We size your opportunity first, then connect, enroll and bill, with evidence for every month.
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1
Step 1 · Free
Free panel assessment
We size your APCM opportunity by level from a de-identified EHR export.
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2
Setup
Connect your EHR
We read chart data and write notes, tasks and care plans back to the chart. We configure your consent scripts and care-plan templates with your clinical lead.
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3
Enrollment
Enroll patients
Your staff or ZenVoice run consent calls, and patients without a recent visit are routed to an initiating visit.
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4
Every month
Bill monthly with evidence
ZenCare checks all 10 elements, assigns the level and queues claims for provider sign-off.
Estimate your own number
More point-of-care automation inside the EHR
ASCVD risk assessment (G0537)
Pulls chart data, runs the ACC Risk Estimator Plus and writes a note with the inputs and the score.
In-EHR eligibility alerts
Flags patients due for diagnostics such as ABI or echo when the chart opens, while the patient is still in the room.
Quality-gap alerts
Shows open measure gaps (for example SUPD) with the steps to close them.
RPM & RTM enrollment
Enrolls eligible patients in remote physiological and therapeutic monitoring with cellular devices.
A new monthly revenue line
Recurring Medicare revenue that helps offset the 2027 conversion-factor cut.
Clean, defensible claims
Every billed month is backed by element-level evidence and a conflict check.
Less charting, more outreach
Drafted plans and task lists replace manual tracking spreadsheets.
ZenCare questions
Do Medicare Advantage plans pay APCM?
APCM is a traditional Medicare fee-schedule payment. Each Medicare Advantage plan decides whether to pay the codes, and some do not. ZenCare tracks coverage by plan so you only enroll patients whose plan pays.
What happens to patients already on CCM?
ZenCare flags them and blocks double-billing. Your clinical team decides whether each patient stays on CCM or moves to APCM.
What if CMS changes the APCM rules?
Level logic and element requirements live in a configurable rules engine that we update for each annual fee schedule, including the optional behavioral health add-on codes.
See what APCM is worth to your panel
A free assessment from your EHR export, with no commitment.
Book a Demo →