Palliative Care Billing - SMARTMD Palliative Care Billing - SMARTMD

Guest post by Mark Hendrix (@nTakthealthcare), Chief Executive Officer, nTakt

Many Palliative Care programs struggle financially. One key component of sustainability involves having an effective Medicare Part B billing process. Here are 5 do’s and don’ts that will lift the profitability of your community-based palliative program.


DO Streamline Documentation

Accurate & complete documentation is essential to minimize claim denials. Providers need a simple (read “low burden”) process that allows them to efficiently record patient encounters and then seamlessly transfer this information to the billing department for processing. Your EHR may have tools that support billing and documentation; if not look for alternatives. Efficient documentation combined with a quicker claims process will have a significant impact on cash flow.

DO Utilize Available Palliative Care Billing Codes

Over the past two years, Medicare has added several new codes that directly benefit Palliative Care. ACP (Advance Care Planning) codes allow providers to bill for helping patients make decisions about the care they want if and when they become unable to speak for themselves. Additionally, Non-Face-To-Face codes allow providers to bill for prolonged evaluation and management services before and/or after direct patient care. Both of these new codes reimburse for care that is essential to delivering person-centered Palliative Care, yet many agencies are not fully utilizing this capability. For a full set of appropriate ACP and Non-Face-To-Face codes, click here.

DO Set and Track the Right Goals

Metrics should keep everyone focused on providing quality care at the right time and in the right place. Start with simple, apparent measures like Revenue per Visit and Visits per Day but be sure to include patient-oriented metrics such as Days from Referral to First Visit to track response time. In addition to tracking goals for each member of the care team, generate the group’s weekly performance and share with everyone. Dashboards are another great way to track status and create shared accountability.

DO Monitor Patient Acuity

Higher acuity patients not only require additional visits but have special needs that, with new billing codes, are now reimbursable for Medicare patients. Even though higher acuity patients require more Palliative Care visits, Medicare recognizes that these visits ultimately reduce Medicare costs by reducing emergency room visits. Better palliative care equals higher reimbursements and lower Medicare costs.

DO Consider Augmenting Your Staff

Whether you’re just starting a Palliative Care program or in the middle of ramping up, finding the staff you need can be a challenge. Hiring in advance of census wastes money while hiring after you’re in a crunch can lead to poor patient service, not to mention staff burnout. Consider contracting an outside service to deal with overflow. Just make sure you’re not tied into any minimums or long-term contracts!


DON’T Underinvest in Technology

Paper and excel spreadsheets may initially be the only option, but don’t be fooled, your valuable clinical staff may be wasting hours on grunt work. On the same note, your inpatient or clinic EHR may be just as poor (sometimes worse) than using paper. Consider technology specifically designed to support your staff in all care settings.

DON’T Go it Alone

Avoid reinventing a process that someone else has already perfected by seeking guidance from a mentor or coach who specializes in Palliative Care operations. True learning only occurs through continually practicing a skill or task with the guidance of a coach or mentor. Consider reaching out to industry organizations such as CAPC and consultants with extensive experience such as nTAKT.

DON’T Forget Travel Cost

Nurses, doctors, and social workers are valuable resources in short supply. Time spent driving is time lost that could be spent caring for patients. A good scheduling app can significantly reduce wasted windshield time. Moreover, when travel is unavoidable, look for apps that help providers utilize that time to get work done.

DON’T Forget Patient Status Often Changes

Patients often transition between Hospice, Palliative Care, and Home Care. As many as 35% of Palliative Care patients eventually need Hospice care. If a patient is not currently hospice appropriate, consider a referral to Palliative Care. Everyone benefits when patient needs are fully met. (Study on terminal patients that fully recover).

DON’T Assume Who is Your Best Referral Source

Growing your census starts with understanding who is referring individuals to your organization, and which referrals are converting into your patients. Without tracking referral data, you’ll never know where to focus your outreach activities. If your EHR doesn’t support referral tracking and analytics, look at third-party options.


Mark Hendrix, CEO nTakt

Mark Hendrix (@nTakthealthcare) has spent the past 3 years as Project Operations Director for a $9.5 million CMMI palliative care grant. The grant focused on standardization of palliative care processes, improving patient outcomes, and developing alternative Medicare reimbursement models. In addition to staffing the model with Nurse Practitioners, Nurses, Social Workers, Chaplains, and an entire administrative team, Mark enrolled and monitored quality and cost data on over 5500 patients during the past 3 years. Mark utilized LEAN concepts such as value stream mapping to optimize processes, reduce patient wait time, and provide the right care at the right time and in the right place. The team developed risk stratification techniques to plan patient care, utilized new billing codes to improve profitability, implemented telehealth to provide care to underserved patients in rural areas, and integrated these new processes into an EMR.

An accomplished operations manager and performance improvement specialist with extensive experience spanning healthcare, manufacturing and service industries. Passionate about continuously improving quality, customer service and value. Exceptional problem solving and motivational skills and the ability to implement sustainable solutions which drive excellence. Self-motivated, articulate, practical, and diligent.