Palliative Care/Serious Illness Support

The whole person

Palliative care sees the whole person beyond the disease.

Person-centered and family-oriented

Person-centered and family-oriented care for people living with serious illness that provides relief from the symptoms and stress of the illness through physical, mental and spiritual support - whatever the diagnosis.

Improving quality of life

The goal of palliative care is to improve quality of life for our members and their families through skilled communication to match care to goals; expert pain and symptom management and coordination of care among the patient's providers.

At any age and any stage

Palliative care is appropriate alongside curative treatment at any age and at any stage in a serious illness.

Palliative Care/Serious Illness Support is a comprehensive set of benefits and supports available to members and their caregivers who are living with serious illness. Our vision is that every person living with serious illness will experience personalized care that is consistent with their values, goals and preference; caregivers will feel included, honored and supported.

Our clinical team will help support providers who are looking for ways to better address the needs of their patients living with serious illness and who may benefit from specialty palliative care.

Member benefits

Member benefits

Our member benefit covers:

  • Adult and pediatric palliative care case management: Assistance with care coordination and benefit navigation with nurses through telephonic support.
  • Home health medical: Assistance with activities of daily living
  • Psychosocial support: Through our expanded home health benefit, members are eligible to receive individual, family and marriage counseling in the home.
  • Caregiver support: Our teams work with the member's and caregivers.
  • Goals of care/advance care planning (ACP) conversations: Provider reimbursement for conducting and documenting goals of care conversations with their Asuris patients.

    • To support our Medicare Advantage members, we cover goals of care/advance care planning (ACP) conversations (CPT 99497 or 99498) at no cost share ($0 copay), regardless of the visit type or place of service.
      • This benefit enhancement applies to telehealth (conducted via audio and video) and in-person visits.
      • To ensure members are supported if their health status and/or wishes regarding care planning change, the benefit covers up to one ACP conversation per day with no annual limit.

Verify your patients' eligibility and benefits using Availity Essentials.

Tips for talking to your patients about palliative care and advance care planning

The Serious Illness Messaging Toolkit includes tips for how to talk about serious illness using evidence-based research.

It includes quick guides for having conversations about these topics:

MA Quality Incentive Program

Medicare Advantage Quality Incentive Program

Providers who participate in our Medicare Advantage Quality Incentive Program (MA QIP) and who complete advance care planning (ACP) conversations or report that an advance care plan has been previously recorded for their Asuris Medicare Advantage patients can earn incentive as follows:

  • 20-29% gaps closed: $10/closed gap
  • 30-39% gaps closed: $50/closed gap
  • 40-59% gaps closed: $70/closed gap
  • 60-79% gaps closed: $90/closed gap
  • 80-100% gaps closed: $110/closed gap

View the eligible claim codes for gap closure in our Quality Measures Guide.

Billing & coding resources

Medicare Advantage palliative care claim submission

Specialty palliative care providers (certified and/or credentialed as palliative care): Medicare Advantage members can receive a specialty palliative care consultation without a copay. The claim for these encounters should include appropriate CPT code(s), along with ICD-10-CM Z51.5 Encounter for Palliative Care as the last diagnosis code. Only certified or credentialed palliative care sub-specialists may use Z51.5.

  • Ancillary providers contracted for expanded serious illness member support (e.g., home health) should continue to submit claims using CPT 1150F.
  • Providers, including primary care providers (PCPs), may not use Z51.5 without palliative care certified clinicians delivering subspecialty level consultation.

PCPs: We encourage you to refer patients who can benefit from palliative care to specialty palliative care providers.

Other billing resources

Billing and coding resources

We reimburse providers for conducting and documenting goals of care conversations, CPT 99497 or 99498 advance care planning (ACP), for all Asuris members.

For Individual and group members, the following codes are eligible for reimbursement (in addition to the ACP codes listed above):

  • CPT 99509 (Home visit for assistance with activities of daily living and personal care)
  • CPT 99510 (Home visit for individual, family or marriage counseling)
Caregiver support

Caregiver support

Our care management supports the unique needs of members with acute, chronic and major illness episodes or severe illness conditions. The mission of care management is to prioritize the needs of our members by providing personalized, equitable services that enhance their wellbeing.

We offer a single-nurse model dedicated to delivering personalized and holistic medical and behavioral health support to each member and their family. Case managers are experienced registered nurses and social workers. Our case managers work closely with providers to help our members improve their health and meet the goals of their providers' treatment plans.

Case managers can:

  • Explain what your loved one’s health plan covers and translate health insurance jargon
  • Help find in-network providers, get pre-authorization for services, schedule appointments and coordinate care
  • Connect you to free or low-cost community resources, like support groups

Learn more about our Care Management program.

Other resources

Other resources

Clinical team model

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Training and education

Our team is focused on increasing access to ACP and specialty palliative care consultation for our members. We offer provider education and training to support increased access and communication training in these areas/interventions.

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Data insights

We can support provider groups with identifying the right members, at the right time, for the right interventions as it relates to serious illness.

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Subject matter expertise

Our clinical team is here to support provider groups with consultation on program design and implementation, best practices for member and caregiver support, and clinical expertise.