Frequently Asked Questions

What is the APCM program?

  • The APCM (Advanced Primary Care Management) program is a Medicare-covered program that began 1/1/2025
  • It includes services like transitional care management (supporting patients discharged from inpatient facilities and emergency rooms to ensure appropriate followup), remote patient monitoring (continuous glucose monitoring for diabetics, etc), offering 24/7 access to the care team and detailed care plans.
  • Who is my care team? It is your doctor, nurse, and whole care coordination and behavioral health team
  • Our practice provides this service to all patients to improve quality and reduce overall healthcare costs to Medicare

Why is Sunflower participating in this program?

  • The workload forced upon primary care physicians and health systems has been intense and ever increasing for several years, without an increase in pay. This program hopes to refocus the importance of primary care and reduce costs in the long run by more closely monitoring our patients with chronic health conditions.
  • More practices are refusing to accept Medicare. We wish to remain a physician-owned practice that can accept a wide range of insurances despite the administrative work required to participate in varying programs.

What does “Medicare covered” mean?

  • Any costs will be covered (aka no cost to the patient) once the patient MEETS THEIR DEDUCTIBLE FOR THE CALENDAR YEAR.
    • This is $265 in 2025 for Medicare part B
  • Patients WILL see charges for this program if they:
    • Do NOT not have a Medicare Advantage/Replacement plan (e.g. Humana Gold, AARP, etc.)
    • Have ONLY Traditional Medicare coverage (red, white & blue card)
    • Have Traditional Medicare coverage and a supplemental Medicare plan (e.g. part D or F, whether it be a federal program or not)

I’ve never had to pay anything for my medical care with Medicare, why is it costing me money now if this program is covered by Medicare?

  • Many supplemental did away with deductible coverage for part B Medicare in 2025. This means that patients are now financially responsible for their part of the deductible when they may not have been in the past.

What are the APCM requirements to earn reimbursement?

  • Obtain patient consent
    • Happens when patients come into the office and sign 2025 registration form
  • Assign a “level” to the patient based on their chronic conditions in HM
    • Level 1: at least one chronic condition
    • Level 2: two or more conditions
    • Level 3: used only for dual-eligible patients (Medicare & Medicare enrolled, few patients at our practice)
  • Provide 24/7 access to care team
    • Via portal and after hours phone line
  • Developing a comprehensive, personalized care plan
    • Care management team and providers working on