| Q.
|
What
is the difference between Care Plan
Oversight (CPO) reimbursement and
reimbursement for Certification
and Recertification of Home Health
Orders? |
| A.
|
CPO
- If a physician spends 30 minutes
or more in a calendar month supervising
and monitoring a patient's Plan
of Care, including, but not limited
to reviewing charts, reports or
Plans of Care and telephone conferences
with other health professionals
involved in the Plan of Care, the
physician may bill for CPO under
codes G0181 or G0182. To bill for
CPO, the physician must document
time spent on Medicare reimbursable
activities for that patient in a
calendar month.
Cert and Recert - If a physician
reviews and signs initial certification
for Medicare-covered Home Health
services, the physician can bill
under code G0180. Physicians may
only bill for code G0810 once during
a patient's Home Health certification
period. Under code G0179, a physician
may bill for signing recertification
orders for Home Health services
after the initial 60-day certification
period is up. Under rate circumstances,
if a patient begins a new episode
before the 60-day certification
period has expired and a new Plan
of Care is required, a physician
may bill under code G0179. Physicians
are not required to document time
spent under codes G0179 and G0180
as required by CPO. |
| Q.
|
How
do I bill for Cert and Resert? |
| A.
|
Utilize
Form 1500 using the appropriate
G-Code (G0180 or G0179), the date,
the charge and the Home Health provider
number. HCFA also recommends including
a copy of the patient's form 485
when submitting a claim. A copy
of the patient's 485 must also be
kept in the physician's office. |
| Q.
|
Can
I bill for Home Health verbal orders? |
| A.
|
No,
you can't bill for verbal orders.
Time spent reviewing and signing
verbal orders is included in the
Cert & Recert. |
| Q.
|
Can
rural health clinic physicians bill
for Cert and Recert? |
| A.
|
No.
Medicare pays the rural health clinic
for their services provided to Medicare
patients. |
| Q.
|
Can
a surgeon bill for Cert & Recert? |
| A.
|
Yes,
if they are the active physician
who has referred the patient for
Medicare covered Home Health services
and who is Certifying or re-certifying
the Plan of Care. |
| Q.
|
How
often does a physician have to have
a face-to-face visit with a patient
to be reimbursed for Cert & Recert? |
| A.
|
A
physician is required to have seen
the patient in the six-month period
prior to certification of Medicare-approved
Home Health Services. |
| Q.
|
When
can I bill for Cert & Recert? |
| A.
|
You
may bill for codes G0179 and G0180
immediately following reviewing
and signing a Cert or Recert of
patient's Plan of Care. However,
if a patient is readmitted to Home
Health with a different Plan of
Care during the same month as the
original Cert or Recert, the physician
can only bill once during that month. |
| Q.
|
under
the Medicare conditions of participation,
am I required to bill the patient
a 20% co-pay? |
| A.
|
Yes,
the patient must be billed for the
co-pay and a "reasonable"
effort must be made to collect. |
For more information on Medicare
billing, contact your local Home Health
Agency or your state's Medicare office.
|
