Current Palliative Care Reimbursement Option Structures
Summary
What makes this type of care so different is that it is based on the symptoms, educational, or resource needs of the patient and not on their prognosis. Though many providers want to offer palliative care, navigating the narrow reimbursement models available can be difficult. This model can also be applied to most state Medicaid programs When billing Medicare or Medicaid, in addition to time or complexity billing and depending on your specific program goals and integration with other healthcare partners, there may be add-on services that would be beneficial to explore, such as transitional care management (TCM), chronic care management (CCM) or remote patient monitoring. Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) are beginning to offer capitated arrangements that are a per-member, per-month reimbursement structure to provide a full suite of palliative care services. If mutually beneficial quality outcomes can be proven, local partners may be willing to directly contract with palliative teams.
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