Advanced Care Planning Allows Patients to Make Informed Decisions About Future Healthcare and End-of-Life Care

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Did you know?

Effective January 1st, 2016, the Centers for Medicare and Medicaid Services (CMS) will reimburse clinicians to have Advance Care Planning (ACP) consultations with their patients.

Why is ACP important to patients and the clinical setting?

Advance care planning allows patients to make informed decisions about future healthcare and end-of-life care. ACP discussions ensure patients’ wishes are respected, should they lose decisional capacity in the future. Good care planning is an essential component of any clinical practice.

What is Advance Care Planning (billable to CMS?)

Advance care planning is an in-person consultation between a physician or nurse practitioner and a patient, family member, or surrogate regarding end-of-life care.

Advance care planning discussions may include:

  • Advance directives, with or without completing the relevant legal forms (i.e., living will, healthcare proxy, DNR orders, and preparation for hospice care).
  • Deciding on what types of treatment a patient would or would not want should they be diagnosed with a life-limiting illness.
  • Options for life-sustaining treatments.

How is ACP reimbursed?

CMS will pay $86 for 30 minutes of ACP in a physician’s office (CPT billing code 99497). An additional 30 minutes of consultation can be reimbursed for up to $75 (add-on CPT billing code 99498).

Frequently Asked Questions

What types of providers can conduct ACP discussions?

CMS will reimburse general practitioners, specialists, and hospitalists to facilitate ACP discussions.

Who can bill CMS for ACP discussions?

A physician or nurse practitioner can bill CMS for their participation and meaningful contribution to end-of-life care discussions.

When should ACP discussions with patients occur?

ACP discussions can be held during an annual wellness exam, or a routine visit for management of a chronic condition. Appointments can also be scheduled solely discuss end-of-life issues.

Clinical indicators that prompt ACP discussions:

  • Two or more hospital admissions for a chronic or life-limiting illness within 12 months
  • Patient resides in a nursing home
  • Unintentional weight loss greater than 10% over 6 months
  • Deliberate non-compliance with treatment
  • Refusing food or fluids

Disease-specific clinical indicators:

Cancer, CHF, chronic lung condition, neurological disease, renal disease.

How long should ACP discussions last in order to be reimbursed by CMS ?

Each ACP discussion must last at least 30 minutes to be reimbursed. CMS may consider pro-rating payment for services lasting less than 30 minutes in the future.

Are patients and/or their families required to participate in ACP discussions?

No, since these services are currently voluntary, Medicare beneficiaries may decline to participate. However, research suggests that most patients are willing and hopeful that their providers will initiate ACP discussions.

Can ACP discussions be conducted via telephone or telemedicine?

No, CMS is only reimbursing in-person ACP discussions at this time.

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