Is Your Medical Claims Billing Software Ready?
The discussion around paying doctors for helping patients with advance care, or end-of-life planning, isn’t a new one, but it finally got traction in 2015. After years of debate around the issue and countless conversations about whether reimbursing physicians for their time consulting the terminally ill is worthy, at the stroke of midnight on January 31, the country decided it finally is.
It’s difficult to talk about death. And difficult for doctors to tell their patients (and their patients’ loving families) that there’s really is no way to avoid it. In America we pull out all the stops to prolong life and pride ourselves on doing “everything we can” to keep folks alive. The reality, however, is that people die every day and the majority of people facing terminal illness don’t necessarily want to exhaust every medical option available. Most want to live out their final days free of pain, in relative peace and with the people they love.
Hence the advance care payment debate. Do we force the difficult conversations?
The government’s first attempt to reimburse for end-of-life planning occurred in the summer of 2009. The proposal was met with swift and furious opposition and so it was tabled until the winter of 2010. That year the administration quietly included the new benefit in a list of regulations that determined the value of various procedures for Medicare. It was a softer approach, but when the inclusion finally made the news, skepticism set in and the attempt was again abandoned. Why? It wasn’t that anyone felt doctors shouldn’t be paid for providing sound medical advice; it was that some considered it an example of the government’s intrusion into health care.
What was the catalyst for change?
In 2012 the medical community joined the conversation. At the meeting of the Illinois State Medical Society that year, several doctors proposed a resolution to ask the American Medical Society to create a billing code for advance care planning discussions. (The AMA creates all the medical billing codes for Medicare. The government regulates how much to reimburse for them.) The doctors based their request on their personal, clinical experience and with that, the AMA agreed. They created 2 new codes and finally, in early July 2015, Medicare published plans to pay for them.
Why should medical billing companies care that such a change has taken place?
Dying is expensive. According to research, the 6% of Medicare patients who die each year account for up to 30% of the program’s annual spend on health care. That means nearly a third of the Medicare’s resources are invested on the dying – and for many of them, the care doesn’t change the outcome. Medicare spent an average of $33,500 on recipients who passed away in 2011 — four times the amount it spent on the recipients who lived.
And in more practical ways, we need to ensure our medical claims billing software can manage the changes. Here’s what you need to know.
In the final ruling on the issue, published late in 2014, the Centers for Medicare and Medicaid Services established the two CPT codes for physicians to document advance care planning conversations. The first covers the initial 30 minutes of discussion. The second is an add-on code for additional 30 minute conversations.
The new codes went into effect for services provided on or after January 1, 2016 and are billable under Medicare Part B. Medical billing companies should be aware (as should administrative and billing staff) that these codes can be used by any physician or non-physician practitioner who bills Part B for their services. Palliative service providers can also bill for advance care planning while most hospice physicians will not.
The conversations included in paid discussions should cover patient goals for care and outcome, specific wishes in terms of advance care, and instruction on advance directives which are necessary for patients, family caregivers and professionals providing terminal care to understand and agree to.
Does your medical claims billing software help keep you compliant in terms of policy changes like this one? Apex EDI’s OneTouch® electronic healthcare claims processing certainly does. Ask us why we’re one of the top-rated medical billing companies in the industry.
