Advance Care Planning as a Medicare Service

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advance care planning
by Amanda Martin

Are you missing out on Advance Care Planning opportunities in your practice?

One of the most challenging topics to bring up with your patient is Advance Care Planning (ACP). This touchy subject brings to light the recognition of aging and dying, which is not usually something people want to think about, whether they are sick or healthy.

Being able to provide valuable information to your patient will help ensure that they can make informed decisions regarding their preferences about the healthcare they wish to receive during the critical final stages of their life.

Advance Care Planning and Advance Directives

As of 2016, Medicare recognized the importance of ACP and began reimbursing qualified healthcare professionals for the time spent with their Medicare-eligible patients, both during their Annual Wellness Visit (AWV) or as a stand-alone visit. While the ACP discussion is considered voluntary and can be done at any time, if the service is performed during the patient’s AWV, there is no cost to the patient. Consequently, when ACP services are performed outside of the AWV visit, coinsurance and deductible will apply. 

Unlike the AWV, there is no limit other than necessity to the number of times the ACP visits can be billed per patient per year. As your patient’s health needs change, it is always a great idea to update their advance directives with new information.  

Why Are ACP Services Important? 

ACP allows patients to consider and share their personal and cultural values, goals, and preferences with their provider and loved ones to develop a plan about the care they wish to receive when they are no longer be able to express their preferences themselves.

It also allows the patient to designate a healthcare proxy to make decisions on their behalf should they become incapacitated. It is also important for the family members of the patient as it gives them some certainty to the patient’s wishes if they are put in the position of making healthcare decisions for them.

Finally, ACP may even lower the cost of healthcare in general, as it can avoid expensive life-prolonging therapies when the patient has made their preferences known.

ACP How-To Details

Due to the unique relationship between Primary Care Providers (PCP) and their patients, PCPs are often best positioned to initiate ACP discussions. ACP discussions should be performed face-to-face and should provide the patient with the following: 

  • A candid talk about any future decisions that may need to be made based on the patient’s individual health history.  
  • Information on how to let loved ones and other healthcare professionals involved in the patient’s care know their specific end-of-life healthcare preferences.  
  • Encourage the patient to choose a healthcare proxy that will follow through with their wishes. 
  • Explain and assist in completing Advance Directive Forms.   

Thorough documentation should be completed during the ACP visit regarding the patient's advance directives and end-of-life wishes. Documentation should be easily understandable and contain actionable orders so that the patient's wishes can be easily interpreted and understood universally by any healthcare professional that may become involved in the patient’s care.

Many providers find the billing and coding guidelines surrounding ACP confusing and therefore avoid billing for these important discussions. The pitfall is that most providers are most likely having ACP conversations with their patients but are missing out on this reimbursement opportunity. A common barrier preventing providers from directly scheduling ACP appointments with their patients and billing for this reimbursement is scheduling and documentation time constraints. Often, ACP appointments take longer than 15 minutes, making impromptu ACP conversations difficult and the required documentation even more daunting.  

Providers can work around time constraints and documentation hurdles by changing workflows and providing more patient education about ACP prior to scheduling the visit. 

When educational materials can be given to the patient prior to the appointment, the patient is better equipped to discuss sensitive topics and can have a plan formulated before their appointment, which may lead to time savings. Medical software can also play an essential role in the logistics of providing and documenting ACP services by ensuring each visit is complete and eliminating human error in meeting all the requirements.

Practice Revenue from ACP

While ACP is often a difficult discussion to initiate with patients, it is well worth your time and effort. When performed and documented correctly, ACP can be billed in addition to an AWV or in addition to other types of visits, such as evaluation and management services (e/m services).

The two primary ACP CPT codes are 99497 and 99498 and pay the provider around ~$86 for the first 30 minutes of face-to-face time and another ~$75 for each additional 30 minutes spent with the patient discussing APS.

Remember, ACP can be updated and billed as many times as necessary to ensure an up-to-date reflection of the patient’s current health and advance directive wishes. 

Don’t Miss Out on the Opportunities of ACP

According to a recent Medscape report, less than 3% of qualifying medical providers are conducting and billing for ACP services. However, one is left to ponder whether this is a true representation of the discussions that providers have with their patients every day. 

Discussing health status and treatment options is something all providers do, so why not capture this underutilized reimbursement opportunity. By taking a few actionable steps to ensure Medicare eligible patients are receiving ACP with your practice, you will ensure patients are receiving the best care possible and that you are capturing every dollar you can.

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