As part of the Obama administration’s latest rule updating the 2016 Medicare Physician Fee Schedule, billing codes and provider reimbursement rates will now be recognized for advance care planning. The ruling, issued on Oct. 30, is effective Jan. 1, 2016.
“This is a victory for ACEP members, who have been advocating for such a provision for years,” said Barbara K. Tomar, federal affairs director at ACEP in Washington, D.C. “We’re so pleased that Centers for Medicare & Medicaid Services (CMS) has assigned codes that recognize the importance of advance care planning.”
In previous rules, only primary care physicians were reimbursed by CMS for care coordination activities. Now, any type of physician may be eligible for reimbursement. But Medicare administrative contractors will have the final say on who is specifically reimbursed, as the rule does not provide a national coverage decision, Tomar pointed out.
In a September 2015 letter to CMS advocating for the then-proposed ruling, then-ACEP President Michael J. Gerardi, MD, FACEP, wrote, “Emergency physicians are on the front line when an elderly patient decompensates…in addition, many [ACEP] members are obtaining additional training for practice in geriatric-focused emergency departments where even more time is spent on advance care planning activities.”
Sandra M. Schneider, MD, FACEP, director of emergency medicine practice at ACEP, said many emergency physicians were already having advance care planning conversations with patients who hadn’t had them with another physician previously, because gaps in the health care system exist. “Emergency physicians are dedicated to doing what’s best for the patient, but we should be reimbursed for having these critical discussions, which are oftentimes lengthy,” she said.
Last year, CMS declined an American Medical Association request to implement new billing codes for advanced care planning. Earlier, lawmakers dropped efforts in 2009 to include such planning in the Affordable Care Act after health reform opponents touted it as the start of “death panels” that would encourage euthanasia.