Medicare Providers Did Not Always Comply With Federal Requirements When Billing for Advance Care Planning

Submitting OIG:

Department of Health & Human Services OIG

Date Issued:

Tuesday, November 22, 2022

Agency Reviewed / Investigated:

Department of Health & Human Services

Submitting OIG-Specific Report Number:

A-06-20-04008

Component, if applicable:

Centers for Medicare & Medicaid Services

Centers for Medicare and Medicaid Services

Location(s):

United States

Type of Report:

Audit

Questioned Costs:

$33,332

Funds for Better Use:

Number of Recommendations:

View Document:

Attachment	Size
62004008.pdf	3.19 MB

Recommendation Number	Recommendation Status	Significant Recommendation
23-A-06-017.01	Open	No
The Centers for Medicare & Medicaid Services should educate providers on documentation and time requirements for ACP services to comply with Federal requirements. (That is, when another service is performed concurrently with a time-based service, the time associated with the concurrent service should not be included in the time used for reporting the time-based service, and time and ACP discussion must be documented). Had the requirements been followed, Medicare could have saved an estimated $42,266,931 during our audit period.
23-A-06-017.02	Open	No
The Centers for Medicare & Medicaid Services should instruct the MACs to recoup $33,332 for ACP services paid in error for claims in our sample.
23-A-06-017.03	Open	No
The Centers for Medicare & Medicaid Services should instruct the MACs, based on the results of this audit, to notify appropriate providers (i.e., those for whom CMS determines that this audit constitutes credible information of potential overpayments) so that the providers can exercise reasonable diligence in identifying, reporting, and returning any overpayments in accordance with the 60-day rule and identify any of those returned overpayments as having been made in accordance with this recommendation.
23-A-06-017.04	Open	No
The Centers for Medicare & Medicaid Services should establish Medicare requirements that address when it is appropriate to provide multiple ACP services for a single beneficiary and how these services should be documented when required to support the need for multiple services.

Recommendation Number

Recommendation Status

Significant Recommendation

Additional Details

23-A-06-017.01

Open

The Centers for Medicare & Medicaid Services should educate providers on documentation and time requirements for ACP services to comply with Federal requirements. (That is, when another service is performed concurrently with a time-based service, the time associated with the concurrent service should not be included in the time used for reporting the time-based service, and time and ACP discussion must be documented). Had the requirements been followed, Medicare could have saved an estimated $42,266,931 during our audit period.

23-A-06-017.02

Open

The Centers for Medicare & Medicaid Services should instruct the MACs to recoup $33,332 for ACP services paid in error for claims in our sample.

23-A-06-017.03

Open