24 Feb Care Plan Oversight

Care Plan Oversight Often Overlooked

Care Plan Oversight (CPO) is often overlooked as a revenue source for physicians. CPO is the physician supervision of patients under either the home health or hospice benefit where the patient requires complex or multi-disciplinary care requiring ongoing physician involvement.

Reimbursement is allowed for the services involved in physician certification/re-certification and development of a plan of care for Medicare covered Home Health Services. Physicians can bill for the time they spend reviewing charts, reports and treatment plans; reviewing diagnostic studies if the review is not part of an E/M service; talking on the phone with other health care professionals who are not employees of the practice and are involved in the patient’s care; conducting team conferences; discussing drug treatment and interactions (not routine prescription renewals) with a pharmacist; coordinating care if physician or non-physician practitioner time is required; or making and implementing changes to the treatment plan.

Care Plan Oversight Often Overlooked Home Health Blog Care Plan Oversight (CPO) is often overlooked as a revenue source for physicians. CPO is the physician supervision of patients under either the home health or hospice benefit where the patient requires complex or multi-disciplinary care requiring ongoing physician involvement. Reimbursement is allowed for the services involved in physician certification/re-certification and development of a plan of care for Medicare covered Home Health Services. Physicians can bill for the time they spend reviewing charts, reports and treatment plans; reviewing diagnostic studies if the review is not part of an E/M service; talking on the phone with other health care professionals who are not employees of the practice and are involved in the patient’s care; conducting team conferences; discussing drug treatment and interactions (not routine prescription renewals) with a pharmacist; coordinating care if physician or non-physician practitioner time is required; or making and implementing changes to the treatment plan.

Physicians, or their Billing Staff, may submit a claim using the following HCPCS Codes:

• G0179: MD Re-Certification of Home Health Patient
• G0180: MD Certification of Home Health Patient
• G0181: Home Health Care Supervision
• G0182: Hospice Care Supervision
•  99201-99263 and 99281-99357 only when there has been a face-to-face meeting/encounter  

Be sure to use the correct dates of service for HCPCS codes G0181 and G0182. Submit the first and last date during which documented care planning services were actually provided during the calendar month. 

• Do not submit the first and last calendar date of the month unless services were provided on those dates)
• Submit the claim after the end of the month in which the service is performed
• Report care planning only once per calendar month
• Report only one month’s services per line item

• Submit HCPCS code G0179 for Re-Certification after a patient has received services for at least 60 days (or one certification period). HCPCS code G0179 may be reported only once every 60 days, except in the rare situation when the patient starts a new episode before 60 days elapses and requires a new plan of care to start a new episode.
• Submit HCPCS code G0180 when the patient has not received Medicare covered Home Health Services for at least 60 days. The initial Certification (HCPCS code G0180) cannot be filed on the same date of service as the supervision service HCPCS codes (G0181 or G0182).

Learn more about revenue generating Home Health Software solutions

Documentation is the key to a success medical record review.  Claims for care plan oversight services will be denied when review of the beneficiary claims history fails to identify a covered physician service requiring a face-to-face encounter by the same physician during the six months preceding the provision of the first care plan oversight service. Medical records for these services must indicate the physician spent 30 minutes or more for countable care planning activities and the specific service furnished, including the date and length of time.

Best Practices for Care Plan Oversight Revenue Awareness

Agencies should spend the time to educate physicians to this reimbursement possibility. Have a simple fact sheet available with the steps to complete the process identified but do not complete the form for the physician. Offer a sample log to physicians so they may see what can be billed.  Provide the link to the CMS site so the physicians may read the complete process outlined by CMS.

For more information on CPO revenue generation opportunities, homecare software technology, or related topics in the home health industry, please email us at HomeHealthSoftware@AloraHealth.com

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