This toolkit has been updated for 2023. Check the virtual events calendar for additional billing Virtual Office Hours and Webinars.

Optimized billing and coding are critical to the financial stability of the palliative care program. Palliative care providers can bill for Part B Professional Services, and revenue from billing often covers a substantial portion of direct costs (staff time).

The degree to which you can cover costs billing fee-for-service (FFS) is impacted by:

  • Quality of documentation and billing processes
  • Mix of team members—who on the team can bill for services, and which staff are counted in your direct costs
  • Place of service (care setting)
  • Contracts with payers and payer mix
  • Proportion of time spent on direct patient care vs. other activities (such as education) that may impact patient care but not be billable

Programs must seek specific interpretation and advice from their local billing staff and regional payer and CMS administrators.

Looking for more information about financing your palliative care program? Browse CAPC's Covering Costs and Generating Revenue toolkit.

What’s in the Toolkit

CMS changes and updates.

A Sip From the Firehose: Key Palliative Care and Hospice Billing and Coding Changes in 2023

In this short webinar, Chris Jones, MD, provides a brief overview of the key 2023 changes to the billing and coding regulations that will affect clinicians who take care of patients with serious illness.

2023 Billing Updates Overview
New
MEMBERS ONLY locked

Summary of January 1, 2023 changes to the Medicare fee schedule, with a focus on relevant codes for the palliative care team.

Are you accurately billing for your services? This collection covers the fundamentals of palliative care billing.

Introduction to CAPC's Billing Toolkit
MEMBERS ONLY locked

A guide to navigating CAPC's billing and coding resources, with pathways for new and experienced palliative care professionals.

Palliative Care Billing 101 (2023 Update)
MEMBERS ONLY locked

The basics of palliative care billing: billing terminology, who can bill, and strategies for reflecting the work of the palliative care team in Medicare billing.

Inpatient Billing: The Fundamentals (2023 Update)
MEMBERS ONLY locked

Review of inpatient E/M codes, including time-based billing vs. medical decision-making, prolonged services, and inpatient billing case examples.

Outpatient Billing: The Fundamentals (2023 Update)
MEMBERS ONLY locked

Review of outpatient E/M codes, including time-based billing vs. medical decision-making, prolonged services, and outpatient billing case examples.

Telehealth Billing Guide
MEMBERS ONLY locked

A summary document of Medicare-reimbursable codes for telehealth and telephone encounters.

Community-Based Billing Estimator
MEMBERS ONLY locked

At-a-glance Medicare RVUs and national non-facility payments for codes commonly used by community-based palliative care programs.

The Palliative Care Team: Who Can Bill?
MEMBERS ONLY locked

How the interdisciplinary team can bill, and the differences between Advanced Practice Provider (APP) independent and APP 'incident to' or 'shared visits' billing.

Payment Quick Tips: Understanding Medicare, Medicaid, and Commercial Insurance
MEMBERS ONLY locked

Monograph introducing U.S. health insurance with a focus on Medicare and what it means for palliative care.

Summary Structure - Medicare Part A and Part B
MEMBERS ONLY locked

Diagram of which services are billed through Part A vs. Part B.

How to Bill for a Medicare Part B Provider
MEMBERS ONLY locked

Guidance on Part B billing for community agencies. Palliative Care of the Bluegrass.

Inpatient Billing and Coding

In this Virtual Office Hour, expert faculty will explore commonly asked inpatient palliative care billing questions and describe billing and coding practices.

Billing for Community-Based Palliative Care

In this Virtual Office Hour, ask questions about billing for services provided in the home, office, or long-term care setting.

Billing for Social Work Services in Palliative Care
MEMBERS ONLY locked

A slide deck detailing the opportunities and considerations for palliative care teams billing for social work services. Courtesy of Brandi Rutan, LCSW, LISW-CP, Four Seasons Clinical Social Worker and Tranquil Counseling & Consulting, LLC and Christine Lau, RN, LCSW, APHSW-C, Sr. Director of Serious Illness Care Management for Teleios and VP of Operations for UNC Community Palliative Care

Guidance on time-based and complexity billing.

Palliative Care Billing 101 (2023 Update)
MEMBERS ONLY locked

The basics of palliative care billing: billing terminology, who can bill, and strategies for reflecting the work of the palliative care team in Medicare billing.

Commonly Used ICD-10 Codes for the Palliative Care Program
MEMBERS ONLY locked

Common ICD-10 codes for palliative care patient encounters. Center to Advance Palliative Care, 2018

ICD-10 CM Official Guidelines for Coding and Reporting (2018)

Center for Medicare and Medicaid Services and National Center for Health Statistics, 2018 ICD-10 CM Official Guidelines for Coding and Reporting.

Medicare Claims Processing Manual

Centers for Medicare & Medicaid Services. Revised October 2017.

Medicare Flexibilities That Support Palliative Care via Telehealth
MEMBERS ONLY locked

A slide deck that reviews the why, what, and how of Medicare payment for telehealth and telephone encounters during the COVID-19 public health emergency.

Telehealth Billing Guide
MEMBERS ONLY locked

A summary document of Medicare-reimbursable codes for telehealth and telephone encounters.

How to bill for ACP services and capture Relative Value Units (RVUs) for this valuable work.

Billing and Coding for Advance Care Planning (ACP) Services
MEMBERS ONLY locked

Requirements, best practices, documentation requirements, and time thresholds for Advance Care Planning (ACP) services. Center to Advance Palliative Care, 2018.

ACP Billing Threshold Times
MEMBERS ONLY locked

Length of time requirements for the Advance Care Planning service CPT codes. Center to Advance Palliative Care, 2018.

Relative Value Units (RVUs) of Advance Care Planning
MEMBERS ONLY locked

Shows the RVUs associated with each Advance Care Planning CPT code. Center to Advance Palliative Care, 2018.

Billing the Physician Fee Schedule for Advance Care Planning Services
MEMBERS ONLY locked

One-page reference guide to billing for advance care planning conversations. Center to Advance Palliative Care and Acevedo Consulting, August 2016.

Advance Care Planning (The ABCs of Getting Paid)

Detail on the intricacies of ACP billing. Coding Leader, 2016.

CMS Advance Care Planning

CMS Requirements for billing Advance Care Planning codes 99497 and 99498. Centers for Medicare and Medicaid Services, updated 2018.

Advance Care Planning Tool
MEMBERS ONLY locked

Incorporates coding, compliance, and CPT II Codes, which can be added for certain preventive care services and test results to more easily track patients and visits. Trinity Health, 2019.

Top 10 Tips for Using Advance Care Planning Codes in Palliative Medicine and Beyond

Jones CA, Bull J, Acevedo J, Kamal AH. Journal of Palliative Medicine, 2015.

Sample Policy: Advance Care Planning Billing
MEMBERS ONLY locked

Example of institutional policy to guide clinicians in providing and billing for ACP services. Shared by Mount Sinai Hospital (Hertzberg Palliative Care Institute), 2016.

Building Physician Skills in Basic Advance Care Planning

Building Physician Skills in Basic Advance Care Planning, includes three courses intended to build person-centered advance care planning (ACP) skills for physicians and advanced practitioners.

CMS ACP Fact Sheet

CMS Medicare Learning Network guidance for advance care planning billing and coding. CMS, August 2019.

Billing for Dementia Care
MEMBERS ONLY locked

Applicable services, how to bill, and documentation requirements for cognitive assessment and care planning for people living with dementia.

Palliative care teams often manage and coordinate care for complex patients with multiple chronic conditions. Learn how to bill for the services you are already providing to patients.

Principal Care Management (PCM)
MEMBERS ONLY locked

Overview of the Principal Care Management (PCM) billing codes and requirements. Updated 2023.

Billing and Coding for Chronic Care Management (CCM) & Complex Chronic Care Management (CCCM) Codes
MEMBERS ONLY locked

Billing for CCM and CCCM, including patient eligibility, which providers can bill, required documentation, and tips for avoiding claim denials. Updated January 2023.

Chronic Care Management in Practice: How, When, and Why to use the CCM & CCCM Codes to Maximize Provider Reimbursement

This webinar examines how CCM & CCCM are critical components of coordinated care that contribute to better outcomes and higher satisfaction for patients.

Connected Care: Health Care Professional Toolkit

Tips for getting started, requirements for implementing a CCM program, and materials to share with patients.

Consent Agreement
MEMBERS ONLY locked

Sample consent agreement required for CCM and CCCM billing. ResolutionCare, 2018.

Certification of Time Spent Sample
MEMBERS ONLY locked

Sample certification of time spent, required for CCM and CCCM billing. ResolutionCare, 2018.

CPO codes are used when managing and coordinating care for patients in Certified Home Health or Hospice agencies. Learn the fundamentals of billing for CPO: who is eligible, who can bill, and what is required.

Billing and Coding for Care Plan Oversight (CPO)
MEMBERS ONLY locked

Care Plan Oversight: who is eligible, who can provide the service, and required service and documentation elements for successful reimbursement. Updated January 2023.

CPO Medicare Claims Do's and Don't
MEMBERS ONLY locked

Tips for billing CPO. Center to Advance Palliative Care, 2018.

Billing for Services in the Community: Supplemental Resource Sheet
MEMBERS ONLY locked

Information for community-based providers about about care plan oversite, transitional care management, and chronic and complex care management. Center to Advance Palliative Care, 2018.

TCM codes are used when managing and coordinating care for patients transitioning from hospitals or other facilities back into the community. Learn the fundamentals of billing for TCM: who is eligible, who can bill, and what is required.

Billing and Coding for Transitional Care Management (TCM)
MEMBERS ONLY locked

Billing for patients transitioning from institutions to the community. Includes which patients are eligible, required services, who can provide services, who can bill, documentation requirements, and mistakes to avoid. Updated January 2023.

Care Management Services Comparison Table
MEMBERS ONLY locked

Summarizes the billing tools available for managing patients that need care management. Center to Advance Palliative Care, updated 2020.

DHHS Transitional Care Management Services

Department of Health and Human Services and Centers for Medicare and Medicaid Service 2016. Transitional Care Management Services.

Billing for Services in the Community: Supplemental Resource Sheet
MEMBERS ONLY locked

Information for community-based providers about about care plan oversite, transitional care management, and chronic and complex care management. Center to Advance Palliative Care, 2018.

Relevant billing codes for palliative care in the ICU and the ED have changed as of 1/1/23. New resources on billing will be posted to CAPC's toolkit very soon.

Billing and Coding for Critical Care Codes in the ICU and ED
MEMBERS ONLY locked

Patient eligibility, which providers can bill, understanding time-based billing, and what documentation is required.

Billing for palliative care services in long-term care facilities.

2023 Billing Updates: Overview 1
MEMBERS ONLY locked

Summary of January 1, 2023 changes to the Medicare fee schedule, with a focus on relevant codes for the palliative care team.

Understanding the complex relationship between palliative care workflow, billing, and RVUs.

RVUs 101
MEMBERS ONLY locked

Why RVUs exist, how they are calculated, and why they are important. Center to Advance Palliative Care, 2019.

RVU 102: Exploring the Relationship Between Provider Work and Payment
MEMBERS ONLY locked

Accurately capturing workload through RVUs, and calculating payment. Center to Advance Palliative Care, 2019.

RVU 103: Work Smarter, Not Harder: Moving the Needle on RVUs
MEMBERS ONLY locked

Steps palliative care teams can take to improve quality and efficiency to increase RVUs. Center to Advance Palliative Care, 2020.

2023 Work Relative Value Units (wRVU) Table: Palliative Care and Hospice
MEMBERS ONLY locked

2023 at-a-glance listing of all wRVUs relevant to palliative care and hospice services across settings.

2023 Work Relative Value Units (wRVU) Simple Modeling Worksheet
MEMBERS ONLY locked

Simple interactive tool for estimating annual wRVU volume ranges with customizable assumptions. Data from 2023 CMS RVU tables (as of 12/19/22).

Get the latest updates in your inbox!