Medicare will pay doctors to talk about end-of-life care planning

Rule creates separate billing codes for advance care planning

The Obama administration on Friday issued a final rule that will allow Medicare to reimburse physicians for having advance care planning conversations with patients.

CMS finalized the rule as part of its Medicare Physician Fee Schedule for calendar year (CY) 2016. The rule will take effect Jan. 1, 2016.

Details of advance care planning reimbursement 

The final rule creates separate Medicare billing codes and provider reimbursement rates for advance care planning, and will allow physicians to include advance care planning as part of patients' annual check-ups. Physicians can also continue to be reimbursed for such discussions that occur during a patient's initial visit after enrolling in Medicare, which is already covered under the program.

CMS said the rule is "consistent with recommendations from a wide range of stakeholders and bipartisan members of Congress." CMS has also said the rule aligns with the American Medical Association's coverage recommendations.

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CMS CMO Patrick Conway said he recognizes "how important these discussions are for patients and families," adding, "We believe patients and families deserve the opportunity to discuss these issues with their physician and care team."

American Hospital Association EVP Tom Nickels said, "We are pleased that CMS is recognizing the important role that advanced care planning services play in encouraging Medicare providers and beneficiaries to discuss and communicate a beneficiary’s treatment preferences."

Other final rule details

Among other changes, the rule also:

  • Finalizes a 0.5% increase in payment for the physician fee schedule in CY 2016, as called for under the Medicare Access and CHIP Reauthorization Act of 2015.
  • Wil apply the Value-Based Payment Modifier in the CY 2018 payment adjustment period to physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists in groups and to such non-physician eligible professionals who are solo practitioners;
  • Waive the Value-Based Payment Modifier for providers participating in the CMS Innovation Center's value-based demonstration programs; and
  • Finalizes several new features for Medicare's Physician Compare website, although CMS scrapped it proposal to put a green check mark next to providers that received  payment bonuses for their performance on quality and cost measures (Rubenfire, Modern Healthcare, 10/30; AHA News, 10/30; CMS fact sheet, 10/30).

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