FAQs about APCM

Background on APCM…

According to Medicare:

“A strong foundational primary care system is fundamental to improving health outcomes, lowering mortality, and reducing health disparities, which is why the Department of Health and Human Services has been taking action to strengthen primary care, including establishing coding and payment for Advanced Primary Care Management services in the 2025 Physician Fee Schedule final rule.”

APCM is a program introduced by Medicare in 2025 to support primary care practices in their transition toward value-based care.  It aims to improve patient-provider relationships and provide reimbursement for risk-stratified care management services.  APCM is designed to be a proactive approach to continuous, personalized healthcare, with a focus on managing patients with chronic conditions.

What is APCM?

APCM is a comprehensive list of requirements that a practice must meet in order to qualify.  APCM requires practices to provide

• Access to Care
• Continuity of Care
• Comprehensive Care Management
• Coordination of Care

For a full description of the requirements, see Advanced Primary Care Services

What are the differences between FFS and VBC?

The American healthcare system is mostly built upon the concept of Fee For Service (FFS), where patients are billed for every qualifying “service” that is performed.  The main problems with the FFS model are potential for overutilization, lack of focus on patient outcomes, fragmented care delivery and rising healthcare costs.

Medicare, with the goal of improving quality of care and decreasing the cost, has a long term goal of promoting Value-Based Care (VBC).  Value-Based Care focuses on patient outcomes and quality of care.  It incentivizes improving patient health, coordinating care efficiently, and prioritizing value over volume.

Primary Care is often considered the backbone of value-based care.

Why am I receiving a bill for APCM?

Most medical charges that patients receive are a direct result of a service that was performed.

APCM charges are different.  APCM charges are billed monthly, regardless of whether the patient received a direct service.  Instead, APCM charges are used to fund the work behind the scenes that traditional FFS does not cover.  It covers the time that providers and staff spend answering questions via our Patient Portal, the coordination of care with specialists via referrals, medication management of refills between visits, preventive care reminders, and so much more.

The following comparison illustrates some of these differences:

At Desert Ridge Family Physicians, we deliver the care and access you deserve

Physician-Led Care

DRFP: Your care is always provided by a board-certified physician.
Others: 1 out of every 4 primary care visits are conducted by a nurse practitioner or physician assistant

Timely Access to Care & Easy Online Scheduling

DRFP: Appointments within 3 days.  Online scheduling for in-person or telehealth
Others: Average wait time is 32 days (Maricopa County).  1 in 2 offices do not offer online scheduling

Direct Communication with Your Care Team

DRFP: Portal messages go directly to your care team; calls are answered by in-office staff.
Others: Calls often routed through call centers and triage services; and some don’t offer portal messaging

Continuity with Your Physician

DRFP: You’ll see your own primary care physician, 97%-100% of the time
Others: 1 out of 3 patients in the U.S. don’t have a regular doctor

Dedicated Medical Assistant

DRFP: You have a medical assistant who knows you
Others: Medical assistants are pooled — no personal connection

Care Coordination & Support

DRFP: We handle referrals, records, authorizations, and medication/vaccine reconciliation
Others: Patients often left to manage these on their own

Seamless Transitions of Care

DRFP: We coordinate with hospitals, ER, and rehab through secure texting and portals.
Others: Minimal if any coordination among providers

After-Hours Support

DRFP: Reach an on-call physician for urgent needs after hours.
Others: Most offices do not offer after-hours on call physician

Personalized Preventive & Chronic Care Management

DRFP: Personalized outreach for preventive screenings and chronic care
Others: Care is often reactive — only addressing issues when they arise

How is the amount of my bill determined?

Currently, only Medicare and Medicare Advantage offer APCM support.  Each insurer has their own reimbursement strategy.

Medicare Part B has a $257 deductible for 2025.  The deductible represents the first $257 of healthcare expenses that a patient is responsible for.  Once the deductible is met, Medicare then has a 20% coinsurance, for which a patient is responsible.

Most Medicare patients also have a supplemental insurance plan.  Some of these supplemental plans cover the deductible, while most will also cover the coinsurance.

For Medicare Advantage patients, Medicare Advantage typically has no deductible or coinsurance (though there are some exceptions to this).

In all cases, the vast amount of APCM costs are covered by Medicare or Medicare Advantage.

If you have a financial hardship, please contact our billing office.