decisionhealth Newsletters, Part B News - 2020 Issue 11 (November)
Review advance care planning charts before OIG starts its audit
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Article Overview
This article discusses Medicare billing and compliance issues for advance care planning services, with emphasis on claim denial trends, documentation concerns, and audit readiness. It is aimed at billing staff, coders, and compliance professionals who work with physician fee schedule claims and want to understand the kinds of documentation and utilization issues that have drawn government review. The article also points readers to related CMS, OIG, and Medicare contractor resources for further guidance.
Why This Topic Matters
Advance care planning claims have shown notable denial rates and are drawing attention from oversight agencies. Understanding the compliance themes discussed in the article can help practices review documentation and billing processes before audit activity intensifies.
Article Sections
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Advance care planning claim trends and denial rates
Summarizes Medicare claim volume trends and denial-rate patterns for advance care planning services over multiple years.
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Compliance concerns and documentation review
Discusses the audit focus, documentation themes, and billing hazards associated with advance care planning claims.
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Resources
Lists related government and contractor reference materials for advance care planning and Medicare compliance guidance.
What You Will Learn
- How advance care planning claims have trended in Medicare data
- What compliance themes are drawing audit attention
- Which documentation and billing areas are associated with denials
- Where to find related CMS, OIG, and contractor resources
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Compliance officers
- Physician offices
- Medicare providers
Codes Discussed
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