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

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Date Issued

Tuesday, November 22, 2022

Submitting OIG

Department of Health & Human Services OIG

Other Participating OIGs

Department of Health & Human Services OIG

Agencies Reviewed/Investigated

Department of Health & Human Services

Components

Centers for Medicare and Medicaid Services

Report Number

A-06-20-04008

Report Type

Audit

Number of Recommendations

Questioned Costs

$33,332

Funds for Better Use

Open Recommendations

This report has 4 open recommendations.

Recommendation Number	Significant Recommendation	Recommended Questioned Costs	Recommended Funds for Better Use
23-A-06-017.01	No	$0	$0
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	No	$33,332	$0
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	No	$0	$0
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	No	$0	$0
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.