Medicare regulations enable physicians to bill for activities related to certification or re-certification of home health patients and for care plan oversight, but physicians must document carefully for care plan oversight claims, according to Peter A. Boling, MD, professor of medicine at Virginia Commonwealth University in Richmond.
Home care claims require the use of the Centers for Medicare & Medicaid Services Common Procedure Coding System rather than Current Procedural Term-inology codes.
The code for initial certification is G0180 and applies to new orders only. The code for re-certification is G0179 and occurs every 60 days unless there is a significant change in condition that requires new orders.
The care plan oversight code is G0181 and can be used if the patient is receiving Medicare skilled home care and if the physician spends 30 minutes or more on care plan work defined as countable by Medicare, Boling says. Activities that can count as time spend on care plan oversight are:
- Speaking with agency professionals.
- Coordinating specialty or urgent care.
- Reviewing physician chart for issues related to home care.
- Reviewing care plans and related forms.
- Reviewing lab data.
- Completing medical equipment forms.
- Reviewing home care agency correspondence.
Time spent speaking with family or other nonprofessional caregivers does not count toward care plan oversight and neither does work performed by a physician’s office staff, Boling explains.
A physician’s claim for care plan oversight will be denied if there is no documentation of these activities in the chart, he adds.
A complex home health patient can generate an additional $130 per 30-day period, Boling points out. "If the physician is already doing the work to oversee the patient’s care plan, then he or she should bill for it," he says.
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