Billing & Financial Sustainability

Billing Manual: This guide focuses on how to effectively bill Medicare for palliative care services.

Sustainability Model: This is the WRPCI model that emphasizes multiple strategies to work toward a PC service that is fully sustainable.

WRPCI Documentation, Billing and Coding Training called "The Team That Does Not Know It Is A Team: From Documenting to Coding to Denials to Revenue to Value"

This workshop educated providers, coders, billers, administration and front-end staff on appropriate documentation components and coding practices that will lead to successful billing practices and greater possibility of long-term sustainability for their organization as local community populations age in place. The end goal is to understand the relationship of documentation, coding and billing practices to successful revenue cycle management, to facilitate effective provision of Palliative Care and related services.

Sustainability Strategies for Community-Based Palliative Care

Stratis Health provides a summary of field-tested approaches and supporting resources to assist rural community-based palliative care programs in identifying financial strategies to support and sustain services. A recorded webinar explores themes and resources captured through roundtable discussions with active rural palliative care programs to understand approaches to supporting a business case for developing and sustaining their services.

Community-Based Palliative Care: Fee-for-Service Strategies for a Financially Sustainable Model

A handbook and accompanying webinar on palliative care fee-for-service billing presented by Jean Acevedo of Acevedo Consulting for the California Health Care Foundation.

Top Ten Inpatient Palliative Medicine Billing and Coding Mistakes (and How to Fix Them This Week)

The article from the Journal of Palliative Care shares common billing and coding mistakes and each mistake is paired with solution that is meant to accurately communicate complex care to payers.

CAPC PC Billing

Full access requires a membership but there is a short video and some guidance.

CAPC Serious Illness Strategies: Driving Value in High-Need Populations

A handbook that contains a summary of implementation best practices for health plans and ACOs driving value in the care of high-need, seriously ill populations.

Hospice vs PC Coding

An FAQ article in the Hospitalist discusses the differences between Hospice care and palliative care medical coding.

Getting reimbursed for community-based PC

The California State University Institute for palliative care discusses how to get reimbursed for community-based palliative care.

Diagnoses and PC Coding

A discussion forum on the AAPC site discusses palliative care coding. Nonmembers cannot start threads or comment but can read this exchange. This site for coder geeks dives into other palliative care coding topics.

Billing palliative care services

This article in Today’s Hospitalist focuses on inpatient physician billing but may have some wider lessons.

FAQ: Physician billing for CCM services

CMS goes into detail on physician use of the CCM codes

Q and A: Coding for Palliative Care

A vendor site on health information management responds to a question about using a diagnosis code for palliative care. ( disclaimer: inclusion of this site does not indicate any endorsement of the services or produces the organization may market)

Lesson Learned from Payer-Provider Partnerships for Community-Based Palliative Care

California Health Foundation supported provider and payer organizations working collaboratively to develop community-based palliative care services for three years, from 2014-2017. Eight key lessons learned are documented and also condensed into a Quick Tips sheet.

Health Affairs

This data chart shows Medicare per capita spending by type of service for those over age 65.

Transitional Care Management MedLearn Matters

A CMS bulletin explains billing for Transitional Care Management services

FAQs for Transitional Care Management

CMS responses to common questions about Transitional Care Management billing.

Chronic Care Management MedLearn Matters

A CMS bulletin explains billing for Chronic Care Management services.

FAQs for Chronic Care Management 2022

CMS responses to common questions about billing for Chronic Care Management services.

Care Management in RHCs & FQHCs (12/2018)

CMS responses to common questions about billing for Care Management Services in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs).