Payer & Government Initiatives

Your partner in navigating a changing regulatory landscape

Aprima has a long history of meeting each and every government certification and regulatory mandate since our inception, helping you to maximize your revenues and avoid penalties. That’s why you can count on Aprima to be your partner every step of the way.

Here are just some examples of how Aprima is helping physicians address the latest updates from government and payers.

Quality Reporting

It’s estimated that 50 percent of eligible professionals will face, or already have been assessed, payment penalties because they were unable to fulfill the Meaningful Use requirements and/or did not adequately report on the Physician Quality Reporting System (PQRS) clinical quality measures.

Aprima makes it easy for your practice to track and report quality measures, helping you demonstrate that you meet the PQRS criteria.

Those who do not satisfactorily report data on quality measures are subject to a negative payment adjustment under PQRS. All eligible providers who do not meet the criteria for satisfactory reporting or participating for 2015 PQRS will be subject to the 2017 negative payment adjustment with no exceptions.

Using our sophisticated and intuitive EHR, you’ll be able to quickly and accurately document aspects of care such as prevention, chronic- and acute-care management, procedure-related care, resource utilization and care coordination.

Population Health Management

Population health management is the collaborative effort of our healthcare system to care for cohorts of patients with similar needs. Aprima has proactively developed tools, dashboards, and workflows to assist providers and practices with their population health efforts. Our software allows providers and staff to easily organize and view patient data by need, and from an individual provider or from multiple providers, resulting in an ability to quickly analyze clinical and business intelligence to make effective decisions. By organizing and managing these patients, the focus can remain on caring for patients instead of managing data. By identifying, monitoring, and treating patients proactively, population health management seeks to improve the overall health of large groups of patients more efficiently thereby reducing costs. Aprima supports and enhances your efforts in this important initiative.


Chronic Care Management and Care Plan Oversight

Medicare’s chronic care management (CCM) program allows providers to bill for time they spend on non-face-to-face care coordination services for Medicare patients who have two or more chronic conditions. Additionally, Medicare’s care plan oversight (CPO) allows a provider to bill for supervision of a patient who is receiving complex and/or multidisciplinary care provided by a participating home health agency or Medicare-approved hospice.

With Aprima’s care management functionality, physicians can more easily document their services for these two programs. Aprima’s CCM and CPO modules help physicians track their time and ensure they receive proper reimbursement from Medicare.

For example, Aprima’s CCM tool includes a “start timer” to help physicians and other clinical staff members more easily track the time they spend on each patient’s chronic care management. At the end of each month, providers can use the module to create a “superbill” and ensure their services are billed accurately for patients who received more than 20 minutes of qualified chronic care management services that month. Thus, primary care physicians can more easily be properly reimbursed for their services in addressing population health.




ICD-10 represents a major change in the way physician practices interact with payers, and many physicians struggle to transition to the new codes.

Aprima helps both providers and staff manage the new and expanded coding requirements. Starting with an intuitive crosswalk from ICD-9 to ICD-10, to prompts to ensure you define the specificity, Aprima makes the transition smooth and easy.

Meaningful Use

Some EHR vendors have found it challenging to meet the new requirements for Meaningful Use, making it difficult for their users to receive all the stimulus program dollars they are entitle to. Not Aprima. As one of the first EHRs to receive Meaningful Use Stages 1 and 2 Certification, Aprima is ready to partner with you for the upcoming Stage 3.

Forward-thinking and proactive, Aprima makes sure our clients have everything they need to succeed by incorporating government mandate criteria into our system.

For example, Aprima selected the Kno2™ interoperability platform to enable its physician practices to easily and cost-effectively help their peers meet the requirements for electronic transmission of Transition of Care (TOC) documents mandated under Meaningful Use Stage 2. With this solution, Aprima enables any provider, not just an Aprima customer, throughout the care continuum, to participate in Direct Messaging communications, regardless of their level of technology adoption.

Accountable Care Organizations

Many of our customers have opted to participate in accountable care organizations (ACO). It is estimated there are more than 740 ACOs providing healthcare services for 23.5 million Americans.

ACOs are groups of doctors, hospitals, and other healthcare providers, who come together voluntarily to give coordinated high quality care to Medicare patients. When an ACO succeeds both in delivering high-quality care and spending health dollars more wisely, the organization will share in the savings it achieves for the Medicare program.

Aprima helps you easily document and report your quality metrics so you can benefit from this shared savings program.

Public Health Reporting and Registries

Aprima has established a partnership with CECity®, an organization that allows our customers to utilize the specialized registries offered by CECity and their partners. These registries help both primary care providers and specialists comply with Public Health Reporting as part of Meaningful Use Stage 2. Additionally, these registries allow providers to compare their performance to other providers who utilize the registries.

Currently, these registries include:


  • American Academy of Allergy Asthma and Immunology Clinical Data Registry
  • American College of Physicians Diabetes Registry
  • American College of Physicians Genesis Registry
  • American College of Physicians Immunization Registry
  • American Gastroenterological Association Digestive Health Recognition Program: Colorectal Cancer
  • American Gastroenterological Association Digestive Health Recognition Program: Hepatitis C
  • American Gastroenterological Association Digestive Health Recognition Program: Inflammatory Bowel Disease
  • American Joint Replacement Registry
  • National Osteoporosis Foundation and National Bone Health Alliance Quality Improvement Registry
  • Oncology Nursing Society Quality Improvement Registry
  • Renal Physicians Association Kidney Quality Improvement Registry
  • Wound Care Quality Improvement Collaborative

Affordable Care Act

Since the Affordable Care Act was signed into law in 2010, in many cases, patient deductibles have risen as much as 67%.

As more people move to high-deductible plans, Aprima is here to help you collect your payments. With our eligibility tool, you’ll know what amount your patients should pay upfront.

If patients can’t pay upfront, Aprima has the ability to allow patients to pre-authorize payments and to automatically send out statements to your patients. Aprima can also automatically handle payment plans and patient payments once all insurance has paid. Additionally, we can electronically process payments

Aprima helps you improve the revenue cycle process by:


  • Collecting co-pays and deductibles more efficiently and effectively
  • Maintaining your patients’ credit card information on file
  • Verifying eligibility
  • Avoiding claims denials

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