Mistakes to Avoid when Billing for Palliative Care.

Here are three mistakes that often result in denial of payment.

1. Report Diagnoses Appropriately – Patients often have multiple chronic conditions that each require their own care plan and specialist visits. Unlike hospice, in which the patient has a primary terminal condition that is reported on the claim, a palliative patient can have a different “primary” diagnosis reported on different claims, depending on the provider’s specialty and what treatments were provided. Failure to report the appropriate diagnosis on the claim – or reporting the same diagnosis on more than one claim – can result in denial of payment.
2. Coordinate with Other Providers who are Seeing the Patient – Providers also need to coordinate who is seeing the patient for what purpose and how it’s reported. Specialists in the same group seeing the patient on the same day can be perceived by the payer as a duplicated service, which of course results in payment being denied even when both services are necessary for the patient’s health and well-being.
3. Document Visit Details and Choose the Right CPT Codes and Modifiers – In addition to the diagnosis and the provider’s specialty, claim reporting is also impacted by the goals of the visit, the location of the service, and even how long the appointment lasts. Choosing the correct CPT code is a vocation in and of itself, which adds another layer of skilled labor onto the overall workflow. From the payer’s perspective, the codes also need to tell a consistent story from one claim to the next, and the clinical documentation needs to be accurate, complete, and supportive of the CPT code and modifiers reported on the claim.