Office of Inspector General Audits Advance Care Planning Billing Codes

​The Coalition to Transform Advance Care (C-TAC) recently shared the results of the Office of the Inspector General (OIG) audit report on providers’ use of the advance care planning (ACP) billing codes. This audit came about because of an initial OIG review in 2020 where some billing irregularities were found. C-TAC was interviewed by the OIG and shared that any billing irregularities were unintentional and likely due to providers being unsure how to use and bill the codes as the Centers for Medicare and Medicaid Services (CMS) guidance was not clear.

The OIG audit revealed exactly that providers did not know how to use or bill the ACP codes. The OIG made recommendations that CMS “educate providers on documentation and time requirements for ACP services to comply with Federal requirements” with which CMS agrees. Unfortunately, even though the audit found the overpayments were not intentional, providers who received the overpayment will have to repay the money.  The repayment applies only to those providers in the audit who were from office settings, not hospice or hospital settings.

Until revised CMS guidance is published, providers who bill for ACP should review the existing CMS guidance on ACP billing, especially in regard to documentation. The guidance says “appropriate documentation must include the content and the medical necessity of the ACP related discussion, the voluntary nature of the encounter, the content of any advance directives (along with completion of advance directive forms when performed), the names of participants in the discussion; and the time spent in face-to-face encounter.  Best practice for the time documentation is to include the start and end time of the face-to -face conversation.*” Contact your Medicare Administrative Contractor (MAC) if you have additional questions.

*Based on the recently presented 2023 Palliative Care and Hospice Billing and Coding presentation available to CAPC members, time in and time out are no longer necessary.  Time is now for all time on day of service no matter where you are (not just unit/floor time; no more of that “>50% counseling and care coordination”).