Palliative Care Billing

Full access to CAPC tools and technical assistance for billing is reserved for members. Read more below, or Log in now if you're from a member institution. To learn more about membership, please call Member Services at 212-201-2674.

 

Palliative Care Billing: Bill for the Work You Do

Phil Santa-Emma, MD, FAAHPM, Medical Director of the Palliative Care Program at Mount Carmel in Columbus, Ohio offers advice on how to effectively bill for palliative care services.

Palliative care clinicians can bill for Part B Professional Services for direct patient care services.  Revenue from billing often covers a substantial portion of direct costs (costs of staff time).  This ratio of cost coverage is heavily impacted by:

  • Quality of documentation by clinicians & billing process by billing staff
  • Mix of providers – who is on the team, and who is counted in direct costs
  • Contracts with payers and payer mix
  • Proportion of team time spent on direct patient care vs. other activities that may impact patient care but not be billable

CAPC continues to compile overview documents and tools to assist palliative care teams as they strive to improve billing practices and outcomes.  Key topics for consideration include:

  • Ensuring that palliative care clinicians are credentialed in hospice and palliative medicine, so that their claims will be processed appropriately
  • Documentation tips that increase consistency and efficiency of documentation
  • Evaluation of options for billing for complexity vs. billing for time
  • Special topics such as billing appropriately for “extended time” codes and interpreting the “face to face” rules
  • Suggested priorities for billing reports and review of performance
  • Working with payers
  • Using data to help improve team consistency and performance

CAPC does not give specific advice about billing, and all advice and examples provided by faculty and by participating organizations is provided for example and illustration only.  Programs must seek specific interpretation and advice from their local billing staff and regional payer and CMS administrators.

Our support will help you identify issues of special interest to palliative care clinicians, incorporate sound management approaches into your practice, and help you set reasonable goals for billing in your budget.  Overview information and examples will also prepare you to ask good questions, interpret results and set reasonable expectations when working with local billing experts.

If you have additional questions and you are a CAPC member, please go to CAPC Central and access our discussion forum. The  NOW forum is a resource for members who want to share information, exchange ideas, and get advice from their colleagues on operational issues affecting their palliative care programs.