Single-Center Study Raises Larger Issues about Proper Billing
March 05, 2020
Two CMS codes for advanced care planning - 99497 and 99498 - were used less than 20 times at a tertiary care center in Iowa in a nearly 3-year period, according to findings published in the Journal of the American Board of Family Medicine. Additionally, the center was successfully reimbursed only about one-quarter of the time, potentially resulting in lost revenues.
Billing errors are not limited to advanced care planning, and the findings from the single-center study speak to larger issues about reimbursement, according to Frank Campbell, MHA, MBA, former chief strategic and business planning officer at the University of Mississippi Medical Center.
According to researchers, where the codes were denied, a registered nurse very skilled in advanced care planning conversations correctly documented the conversation and its duration, but due to Medicare billing rules was not considered a licensed provider for these conversations.
"Each of those codes reimburse health systems about $80," Daly told Healio Primary Care. "That's not a huge amount of money. But it's better than nothing, and if you could get that amount for at least 100 patients, that could mean a little extra for your bottom line."