This resource is intended to assist home based medical care providers with effectively managing Chronic Care Management (CCM) services, inclusive of guidance on how to
Use these CPT codes in your wound documentation for debridement services.
This resource is intended for home-based primary care (HBPC) providers and practice staff and defines the 2026 face-to-face documentation requirements for Transitional Care Management (TCM)
This resource is intended for home-based primary care (HBPC) providers and practice staff and defines the 2026 requirements for the interactive contact required of clinical
This resource is intended for home-based primary care (HBPC) providers and practice staff to provide procedure recommendations for replacement of tracheostomy tube in the home
Hierarchical Condition Category (HCC) Coding is the risk adjustment methodology used by the Centers for Medicare and Medicaid Services (CMS) and other programs to determine
This resource is designed to guide house call programs in the use of remote patient monitoring services to care for their patients following the expansion
This resource serves as a comparative guide to support healthcare providers in evaluating and selecting between Advanced Primary Care Management (APCM) and Chronic Care Management
This resource is intended for home-based primary care (HBPC) providers and practice staff to describe step-by-step instructions for performing knee aspirations and injections in the
A comprehensive resource designed to provide guidance to home-based medical care programs in the use of telehealth services to care for their patients with the
A comprehensive list of the primary services that a home-based medical care practice would bill and submit for reimbursement. Includes CPT® codes, location of service
A comprehensive resource to assist home-based medical care providers and practice staff with understanding the advanced coding opportunities beyond Evaluation and Management (E/M) Current Procedural
This resource is intended to serve as a reference for home-based providers that review the Evaluation and Management (E/M) documentation and coding guidelines on the
This resource is intended for home-based primary care (HBPC) providers and practice staff to provide procedure recommendations for replacement of gastrostomy tube in the home
This comprehensive Chronic Care Management (CCM) toolkit equips healthcare providers with essential guidance and resources to successfully implement and sustain a CCM program. It covers
This resource is intended for home-based primary care (HBPC) providers and practice staff and provides an overview of the 2025 required elements for the Chronic
This toolkit equips home-based primary care teams with practical guidance for implementing Advanced Primary Care Management (APCM). Topics include starting an APCM practice, staff communication,
This resource is intended for home-based primary care (HBPC) providers and outlines the required elements of a comprehensive Advanced Primary Care Management (APCM) care plan.
This resource is intended for home-based primary care (HBPC) providers and practice staff and assists with the creation of a template for annual wellness visits
This resource equips home-based primary care (HBPC) providers with practical, evidence-informed strategies to identify, assess, and mitigate caregiver burden. It provides validated tools, standardized workflows,
This Word document outlines two phases of the implementation roadmap for launching a Home‑Based Primary Care (HBPC) program for Andwell Health Partners, developed by the
The presentation outlines the essential components of developing a business plan for a Home‑Based Primary Care (HBPC) program, including considerations of a market analysis, financial
hccintelliThis resource offers guidance on implementing HCPCS add-on code G2211 for home and assisted living visits, as outlined in the CY 2026 Medicare Physician Fee
This presentation introduces Phase 1 of the New Program Implementation process for Andwell Health Partners through the HCCInteractive Solutions Package. There is a special focus
Use this resource as a guide to posting an open position for a registered nurse specializing in HBPC.
This resource provides targeted staff retention guidance for home-based medical care teams, recognizing the distinct roles, motivations, and stressors faced by clinical providers, practice leaders,
A resource designed to help home-based care organizations define the scope, responsibilities, and qualifications for social work roles supporting patients and families in their homes.
A framework designed to help home-based care organizations clearly define the responsibilities, qualifications, and expectations for the Medical Assistant (MA) role. It provides a structured
A foundational resource designed to help home-based care organizations define the scope, responsibilities, and qualifications for a leadership role supporting mobile clinical teams. As a
A foundational tool designed to help home-based care organizations define the scope, responsibilities, and qualifications for RN roles delivering care in patients’ homes. It offers
A flexible framework designed to help home-based care organizations define the scope, expectations, and qualifications for clinical roles delivering care in patients’ homes. As a
Use this resource as a guide to posting an open position for a registered nurse specializing in HBPC.
A structured, role-specific resource designed to support hiring managers in conducting consistent and effective preliminary interviews for key positions in home-based care. Typically used before
This guide provides structured criteria for evaluating resumes across key roles in home-based medical care - including leadership, clinical providers, and administrative staff. It supports
This resource equips hiring managers in home-based medical care organizations with practical strategies to expand and strengthen their recruitment networks. By focusing on targeted candidate
A strategic resource designed to help home-based care organizations attract mission-aligned candidates by developing and communicating a compelling Employer Value Proposition (EVP). It guides recruiters
This toolkit is intended to guide house call providers in conducting a comprehensive medical history and physical exam that identifies cognitive concerns, neurological risks, and
Empower your care team with a comprehensive, easy-to-use APCM Care Plan Template designed specifically for home-based primary care providers. This customizable tool streamlines patient care
This resource is intended to assist home-based medical care providers with the implementation and delivery of Advanced Primary Care Management (APCM) services. It provides structured
This comprehensive Chronic Care Management (CCM) toolkit equips healthcare providers with essential guidance and resources to successfully implement and sustain a CCM program. It covers
This resource document is designed to support recipients of the Innovation Award in promoting their participation in this unique learning opportunity. It includes key messaging,
This resource is intended to help clinicians and practices determine metrics for evaluating operational efficiencies, productivity, and patient outcomes. While not an exhaustive list, HCCI
Wound prevention is key in protecting your patients from unnecessary wounds. This resource is intended to walk you through different prevention strategies.
Wound dressings should always be assessed when examining wounds. If the dressing is saturated, it may indicate that moisture is a concern. Wounds that are
Storytelling is a powerful tool that can help healthcare providers connect with patients, caregivers, and the wider community in a more meaningful way. It humanizes
This Marketing Toolkit is designed for healthcare providers, health systems, and independent practices focused on delivering home-based primary care (HBPC). This toolkit offers practical resources
Outlines key precautions for reducing safety risks during house calls, practical tips for planning, transit, and visit execution, as well as guidance for maintaining communication
To provide guidance on designing a user-friendly, informative website for a home-based primary care (HBPC) practice, the layout should include sections that clearly communicate the
This toolkit is intended to help your practice understand how to promote the importance of home-based medical care in your community, particularly to potential patients
This resource describes home-based primary care (HBPC) and how it differs from other types of in-home care. It is intended to increase awareness among healthcare
This resource was created to provide clarity around the patient qualifications and provider documentation requirements for home oxygen equipment.
Developed in consultation with a long-time caregiver and member of HCCI Practice Advisory Group, this resource aims to increase awareness of HBPC among caregivers, including
This resource list the recommended supplies that providers should carry each day in order to effectively perform procedures and provide quality care to patient each
The Provider Orders/Instructions Form is a comprehensive document designed to convey clear and precise healthcare directives from a physician to the patient and other healthcare
This resource was created to provide clarity around the patient qualifications and provider documentation requirements for standard wheelchairs, power mobility devices and hospital beds. The
This resource is intended for home-based primary care (HBPC) providers and practice staff and provides an overview of infection control.
This resource is intended for home-based primary care (HBPC) providers and practice staff to assist practices that are starting, growing or adding a home-based primary
This resource is intended for home-based primary care (HBPC) providers and practice staff to provide suggested talking points and topics of discussion for practices that
This resource is a communication guide for staff who conduct intake calls and/or respond to calls from patients and/or caregivers interested in enrolling in a
Assist patients and caregivers with identifying local specialty providers, services, and resources to support with the interdisciplinary care of frail, medically complex, and chronically ill
This resource assist in identifying specific benefits a customer can expect from you to help write your Unique Value Proposition.
IDT meetings are an important tactic for house call programs to use to promote optimal care, quality outcomes, and team communication, often leading to improved
This resource is intended for home-based primary care (HBPC) providers and practice staff to assist practices in developing an effective strategy for meeting with payers
This survey seeks to assess various aspects of the healthcare experience, considering the perspectives of both those directly receiving care and those providing crucial support.
Semi-customizable & downloadable form used to gather important information about a patient’s past and current health status. This includes questions about the patient's medical history,
The Patient Demographic Intake Form is designed to collect key information about individuals seeking healthcare services. Serving as the foundational record in a patient's medical
This contract serves as a vital document establishing a clear and comprehensive understanding between healthcare providers and patients regarding the responsible and appropriate use of
This form empowers individuals to control the disclosure of their health information. By signing this form, patients grant explicit consent to a specified organization to
This resource is intended to provide home based medical care providers and practice staff an overview of the basic understanding of Social Determinants of Health
