With seniors expected to outnumber children by 2030, the need for hospice and palliative care is increasing every day. In addition to the increasing demand on the healthcare system, stricter and more complex federal regulations make it more and more difficult for providers to maintain compliance, bill accurately, and receive maximum reimbursement for services provided. And just to add more pressure, extensive documentation is vital to ensure safety in case of an audit. We are sharing with you three mistakes to avoid when billing for palliative care in this blog.
Due to the complexity, billing for palliative care often becomes a missed opportunity – one that could make the difference between a thriving organization or one that struggles under unnecessary financial stress. Obstacles abound that can prevent successful filing and reimbursement of palliative care claims. In many ways, billing for palliative care is just as complex as providing the care itself. Factors such as the diagnosis, the type of specialist the patient is seeing, the location where the services are provided, and even the amount of time required all impact billing.
Mistakes to Avoid when Billing for Palliative Care.
Here are three mistakes that often result in denial of payment.
- 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.
- 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.
- 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.
Taking all these factors into consideration, it’s crucial to have an EMR system that helps navigate the complexities of billing for palliative care while reducing the amount of time it takes to document and bill accurately in order to receive proper payment. There are numerous ways an EMR system can meet these needs – download our Palliative Billing Info Sheet for more information.
Palliative care is an increasingly vital part of the healthcare system, and providers deserve to be reimbursed completely and accurately for this critical service. With the right billing system, appropriate payment for palliative care becomes both more achievable and more efficient.
Curantis Solutions is here for you.
Curantis Solutions is the first palliative care software to fully integrate the advanced care planning documentation practices with the visit complexity, time, CPT codes and KPIs of palliative care to create a comprehensive solution for elevating the performance of a palliative care program. We’re setting the standard for high performing palliative care programs across the country! Ready to schedule a demo, reach out here.
Interested in learning more about Palliative Care. Check out — Top 5 Keys to Success with Palliative Care.