1. Oregon Hospice and Palliative Care Association September 25, 2018
Incorporating Palliative Care into your Hospice Organization
Oregon Hospice and Palliative Care Association
September 25, 2018
Presented By:
Leslie Foren, MBA Palliative Care Provider & Consumer Outreach
© 2018 Regence BlueCross BlueShield of Oregon, all rights reserved.
Regence BlueCross BlueShield of Oregon is an Independent Licensee of the Blue Cross and Blue Shield Association

2. Presentation Objectives:
Working knowledge of the key components of Advance Care Planning (ACP) conversations. How to initiate the conversation, follow up and document goals of care.
Learn key essentials to establishing effective hospice/palliative care provider – payer partnerships.
Have a clear understanding and clarification on when and how to bill for palliative care services using “incident-to” professional services.
© 2018 Regence BlueCross BlueShield of Oregon, all rights reserved

3. Key Components of Good Communication
The Four Habits Model – Physician's Communication Tool
Invest in the Beginning: Create rapport, Draw out patient concerns, Plan the conversation (even brief ones).
Elicit the Patient’s Perspective: Ask for the patient’s ideas, Elicit specific requests, Explore the impact on the patient’s life.
Demonstrate Empathy: Be open to patient and family emotions, Make at least one empathic statement, Convey empathy nonverbally, Be aware of your own reactions.
Invest in the End: Deliver information, Provide education, Involve the patient in making decisions (and family if appropriate).
Source: The Permanente Medical Group, Inc. Physician Education and Development
© 2018 Regence BlueShield, all rights reserved. Private and confidential.

4. Key Components of ACP Conversations
Establish the patient’s awareness of their medical condition
“What is your understanding of what’s going on?”, or
“What have they told you is the problem?”
Establish goals
“What’s the most important thing to you right now?”
Determine support
“Who do you turn to in times like these?”
Connect the dots
“Who should I check with or send records to for you?”
© 2018 Regence BlueShield, all rights reserved. Private and confidential.

5. Key Essentials to Working with your Payer
Communication
Connecting with provider representative, consultants and contractors
Understanding necessary requirements
Licensing / Contracting / Credentialing
Coming forward with a clear definition and realistic expectations about proposed pilot projects
Defining your service, know what it costs and how to scale and share performance guarantees or standards
Understanding of each others process and timelines
Claims runout and data sharing
Patience!
© 2018 Regence BlueShield, all rights reserved. Private and confidential.

6. Palliative Care Reimbursement
Medicare
Advance Care Planning CPT codes
Part A – Nursing, social work and spiritual visits
Part B – some services and supplies to treat disease
Medicaid
Some treatments and medications, physician visits
Private insurance/HMO’s/Managed Care
Palliative care benefits – may be included in Disease Management, Care Management or Hospice programs
© 2018 Regence BlueShield, all rights reserved. Private and confidential.

7. Incident To Billing Overview
Incident To Billing Overview
APRN Incident To Billing Overview
APRN
Services are billed under physician’s NPI number.
Performs health services under direct supervision.
Must be an employee or independent contractor of a physician group if service is performed in a satellite office.
Physician
Initiates course of treatment and care plan for each new problem.
Provides subsequent treatment.
Must be physically present.
Must initiate new course of treatment and care plan if a new problem arises.
The Three Locations Incident To Billing IS allowed
Office
Patient’s home
Office within an SNF
Eligibility – patient
Must be non-hospice (includes Medicare Hospice Benefit recipient)
Incident To Billing NOT allowed
Under Medicare Hospice Benefit
In inpatient setting for Medicare patients
When visits occur outside an office, home or SNF office OR for a hospice patient
If the service occurs in a satellite office where no physician is present
Services under Incident To Billing
Transfer of Service
Consultation/Initial Evaluation
Subsequent Visits
© 2018 Regence BlueShield, all rights reserved. Private and confidential.

8. Resources & Education
The California State University free tool “The Ensuring Success Checklist” -
Center to Advance Palliative Care (CAPC) –
Center for Medicare & Medicaid Services Incident To Billing information - MLN/MLNMattersArticles/downloads/se0441.pdf
© 2018 Regence BlueCross BlueShield of Oregon, all rights reserved.

9. Questions & Discussion
Contact Information:
Leslie Foren, MBA Palliative Care Provider & Consumer Outreach
© 2018 Regence BlueCross BlueShield of Oregon, all rights reserved.