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Cert/Recert/Care Plan Oversight

Medicare reimburses physicians for their time in certifying, recertifying, and providing care plan oversight for home health care patients.

G0180
Certifying a home health care plan
$70.27

G0179
Recertifying a home health care plan
$53.38

G0181
Care plan oversight-homecare
$121.30

G0182
Care plan oversight-hospice
$126.90

Source: http://www.cms.hhs.gov/pfslookup/02_PFSsearch.asp. To assist physicians Promise Care NJ LLC is able to provide complimentary reports for the patients they have certified or recertified. Physician Certification of Home Health Plan of Care (HCPCS Code G0180)

Physicians may bill for the initial certification of Medicare-covered home health services. The physician billing for physician certification must be the provider supervising the patient's care. Services under this category include:

Review of initial or subsequent reports of patient status

Review of the patient's responses to the Oasis assessment instrument

Contact with the home health agency to ascertain the initial implementation of the plan of care

Documentation in the patient's record

Physician Recertification of Home Health Plan of Care (HCPCS Code G0179)

 

Physician services for recertification of Medicare-covered home health services may be billed after a patient's initial certification period (60 days). This recertification may be reported only once every 60 days, except in the rare situation when the patient starts a new episode before 60 days lapse and requires a new plan of care to start a new episode.

G0179 does not apply to "change orders" or to other documents that a home health agency sends for physician signature throughout the care process. Physicians should consider the time spent reviewing that paperwork to be part of care plan oversight and count it toward the time billed as care plan oversight under HCPCS code G0181.

Note:
The billing date for each certification or recertification is that date that the physician signed the plan of care, not when the home health agency began providing care.

All medical record documentation (date, service, and length of time) must be maintained by the physician certifying/recertifying the home health services and must be made available to the Medicare contractor upon request. While Medicare does not require the physician to submit the documentation, it is recommended that the physician retain a copy of the signed HCFA-485 (home health plan of care), signed interim or telephone orders, or any other documentation that would support provision of these services.

Cert-Recert Reports and Care Plan Oversight (CPO)

Medicare reimburses physicians for their time in certifying, recertifying and providing care plan oversight for home health care patients.

Care Plan Oversight (Codes G0181-homecare; G0182-hospice)

Physicians may bill for the care plan oversight of their Medicare home care patients requiring complex treatment by multidisciplinary teams and under the care of a Medicare-approved home health agency or hospice. These cases would involve regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other studies, communication with other health professionals not employed in the same practice who are involved in the patientís care, integration of new information into the care plan, and/or adjustment of medical therapy. When care plan oversight totals 30 minutes or more within a calendar month, physicians can bill for reimbursement.

To receive payment, the physician:

  • Must provide service to Medicare beneficiaries receiving covered home health/hospice services
  • Must have had a face to face encounter with the patient in the six months prior to the first billing for care plan oversight services
  • May not have a relationship with the home health agency that is prohibited by the Stark II (Physician Self-Referral) regulation

Note:
Do not count the work of G0180 or G0179 toward care plan oversight if it has already been billed separately, since that would, in effect, amount to billing twice for the same service.

How to Bill for Care Plan Oversight

Use the 1500 form with the appropriate code and include:

  • dates of CPO activity
  • times of CPO activity
  • charge
  • provider number

Note:
The dates for CPO billing should begin from the start date of the first CPO service to the last, rather than from the patient's episode of care dates.


Disclaimer
This article was prepared as a public service and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents.



 
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