Shared Decisions and Medical Choices: Paying for the “Conversation.” CMS and Advance Care Planning

Shared Decisions and Medical Choices: Paying for the “Conversation”

CMS and Advance Care Planning

A Follow-Up from October’s “Getting to Value” Presentation with John Carney

Beginning this year, Medicare is reimbursing for physicians and other qualified providers to conduct advance care planning visits with patients and their proxy decision makers to improve shared decision making. The codes for the billing are related to 30-minute time periods spent discussing patient preferences and goals of care. The patient does not have to be facing life- limiting illness and the discussions may be combined with an annual wellness visit, with proper documentation regarding the voluntary nature of the discussion. When included as an optional element of the annual wellness visit, the deductible and coinsurance are waived. The discussion does not have to result in the execution of advance care planning documents or legal forms. Trained qualified health professionals, may also provide the service as long as the provider (e.g., clinic) is an approved Medicare Part B provider or other entity, such as a critical access hospital. Currently, there is no limit to the number of sessions, but proper documentation must accompany the billing.

The voluntary nature of the advance care planning visit, which may occur independent of other Evaluation and Management (E&M) services must also be documented. Support materials and tools in facilitating the patient and family discussion and engaging in the conversation may be shared with the family during the visit. Discussions may take place with agents or family members if the patient is unable to participate fully in the conversation.

Training for professionals in how to conduct a visit and engage families in the conversation is available through the Center for Practical Bioethics at https://practicalbioethics.org/resources/caring-conversations/order-prints. In addition, printed materials and conversation support tools are available online or by calling the Center. For more information contact Matthew Pjecha at 816.979.1366.

John G. Carney, President, Center for Practical Bioethics, Kauffman Foundation

Click here to view the slides from John Carney’s “Getting to Value” Event Presentation: Shared Decisions and Medical Choices: Paying for the “Conversation” CMS and Advance Care Planning on the Members-Only Resources page.