This toolkit has been updated for 2024. Join upcoming Virtual Office Hours on inpatient and community-based billing 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

An introduction to CAPC's billing resources, and overview of CMS changes and updates effective January 1, 2024.

2024 Billing Updates Overview
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Summary of January 1, 2024 changes to the Medicare fee schedule, with a focus on relevant codes for the palliative care team.

Social Determinants of Health Risk Assessment
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Codes and RVUs, requirements, and special considerations for billing for a SDOH risk assessment. Center to Advance Palliative Care, January 2024.

Billing for Community Health Integration
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Defining community health integration, Medicare requirements, and considerations for palliative care teams. Center to Advance Palliative Care, January 2024.

Principal Illness Navigation
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CMS codes and requirements, and tips for palliative care teams. Center to Advance Palliative Care, January 2024.

Billing for Complexity Add-On
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Definitions, code requirements, and when to bill the complexity add-on. Center to Advance Palliative Care, January 2024.

Caregiver Training Services
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New codes for individual and group caregiver training - when and how to bill. Center to Advance Palliative Care, January 2024.

2024 New Codes Comparison Table
New
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A summary of the new codes introduced in 2024: Social Determinants of Health Risk Assessment, Principal Illness Navigation, Community Health Integration, Billing for Complexity Add-on, and Caregiver Training Services

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

Palliative Care Billing 101
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The basics of palliative care billing: terminology, who can bill, and strategies for reflecting the work of the palliative care team in Medicare billing. January 2024

Inpatient Billing: The Fundamentals (2024 Update)
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Review of inpatient E/M codes, including time-based billing vs. medical decision-making, prolonged services, and inpatient billing case examples. January 2024

Outpatient Billing: The Fundamentals (2024 Update)
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Review of outpatient E/M codes, including time-based billing vs. medical decision-making, prolonged services, and outpatient billing case examples. January 2024

Prolonged Services Billing (2024 Update)
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Deep dive on prolonged services billing in all care settings. January 2024

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

Community-Based Billing Estimator
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At-a-glance Medicare RVUs and national non-facility payments for codes commonly used by community-based palliative care programs. Center to Advance Palliative Care, 2024

The Palliative Care Team: Who Can Bill?
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How the interdisciplinary team can bill, and the differences between Advanced Practice Provider (APP) independent and APP 'incident to' or 'shared visits' billing.

Commonly Used ICD-10 Codes for the Palliative Care Program
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Common ICD-10 codes for palliative care patient encounters. Center to Advance Palliative Care, 2024

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.

Payment Quick Tips: Understanding Medicare, Medicaid, and Commercial Insurance
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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
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Diagram of which services are billed through Part A vs. Part B.

Billing for Social Work Services in Palliative Care
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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. January 2024

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
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Requirements, best practices, documentation requirements, and time thresholds for Advance Care Planning (ACP) services. Center to Advance Palliative Care, January 2024.

ACP Billing Threshold Times
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Length of time requirements for the Advance Care Planning service CPT codes. Center to Advance Palliative Care, last reviewed January 2024.

Relative Value Units (RVUs) of Advance Care Planning
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Shows the RVUs associated with each Advance Care Planning CPT code. Center to Advance Palliative Care, last reviewed January 2024.

Quick Tips: Billing the Physician Fee Schedule for Advance Care Planning Services
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One-page reference guide to billing for advance care planning conversations. Center to Advance Palliative Care and Acevedo Consulting, January 2024

Medicare Learning Network Fact Sheet: Advance Care Planning

CMS Requirements for billing Advance Care Planning codes 99497 and 99498. Centers for Medicare and Medicaid Services, updated February 2023.

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.

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.

Billing for Dementia Care
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Applicable services, how to bill, and documentation requirements for cognitive assessment and care planning for people living with dementia. January 2024

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)
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Overview of the Principal Care Management (PCM) billing codes and requirements. Updated 2024.

Billing and Coding for Chronic Care Management (CCM) & Complex Chronic Care Management (CCCM) Codes
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Billing for CCM and CCCM, including patient eligibility, which providers can bill, required documentation, and tips for avoiding claim denials. Updated January 2024.

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

Sample (C)CCM Consent Agreement
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Sample consent agreement required for CCM and CCCM billing. ResolutionCare, 2018.

Certification of Time Spent Sample
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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)
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Care Plan Oversight: who is eligible, who can provide the service, and required service and documentation elements for successful reimbursement. Updated January 2024.

CPO Medicare Claims Do's and Don'ts
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Tips for billing CPO. Center to Advance Palliative Care, January 2024.

Billing for Services in the Community: Supplemental Resource Sheet
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Information for community-based providers about care plan oversite, transitional care management, and chronic and complex care management. Center to Advance Palliative Care, January 2024

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)
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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 2024.

Care Management Services Comparison Table
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Summarizes the billing tools available for managing patients that need care management. Center to Advance Palliative Care, January 2024

Medicare Learning Network Fact Sheet: Transitional Care Management Services

Department of Health and Human Services and Centers for Medicare and Medicaid Services, updated May 2023.

Billing and Coding for Critical Care Codes in the ICU and ED
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Patient eligibility, which providers can bill, understanding time-based billing, and what documentation is required. Center to Advance Palliative Care, 2024

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

RVUs 101
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Why RVUs exist, how they are calculated, and why they are important. Center to Advance Palliative Care, updated January 2024.

RVU 102: Exploring the Relationship Between Provider Work and Payment
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Accurately capturing workload through RVUs, and calculating payment. Center to Advance Palliative Care, updated January 2024.

RVU 103: Work Smarter, Not Harder: Moving the Needle on RVUs
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Steps palliative care teams can take to improve quality and efficiency to increase RVUs. Center to Advance Palliative Care, updated January 2024.

2024 Work Relative Value Units (wRVU) Table: Palliative Care and Hospice
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Common CPT Codes with wRVU relevant to palliative care and hospice services across settings with average national payment.

2024 Work Relative Value Units (wRVU) Simple Modeling Worksheet
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Simple interactive tool for estimating annual wRVU volume ranges with customizable assumptions. Data from 2024 CMS RVU tables.

Tools to make the case for palliative care resources and financial partnerships, including the palliative care evidence base and downloadable tools for presenting the case. Includes 27 resources.
Improving productivity and efficiency to ensure team health and operating within budget. Includes 21 resources.
Payment, billing, and fundraising tools for inpatient and community-based palliative care programs. Includes 23 resources.

See all 47 Toolkits

Virtual Office Hours

Inpatient Billing and Coding

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Christopher Jones

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