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HOW TO BILL MCR FOR HOME HEALTH CARE OF PLAN CLAIMS?

Salma Posted Thu 13th of January, 2011 14:08:13 PM

I have problem with hospice and home health claims. I USED CPT CODES FROM 99374,99375,99380,G0180,G0181 MCR DENIED ALL OF THEM. I MUST BE DOING SOMETHING WRONG. PLEASE HELP

SuperCoder Answered Fri 14th of January, 2011 17:55:47 PM

CPT codes 99379 and 99380 are defined for care plan oversight services provided to beneficiaries in nursing home facilities or skilled nursing home facilities (places of service = 31, 32, or 33) and are not separately reimbursed by Medicare since these services are bundled into other Evaluation and Management (E&M) codes. Providers may not bill beneficiaries for these services as non-covered services.

G0181 Physician supervision of patient receiving Medicare covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other studies, communications (including telephone calls) with the other health care professionals involving in the patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month, 30 minutes or more

G0182 Physician supervision of patient under a Medicare-approved hospice (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other studies, communications (including telephone calls) with the other health care professionals involving in the patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month, 30 minutes or more

Separate payment may be made for HCPCS code G0181 or G0182 if the following requirements are met:

1. The beneficiary must require complex or multidisciplinary care modalities requiring ongoingphysician involvement in the patient's plan of care;
2. The CPO services should be furnished during the period in which the beneficiary was receiving Medicare covered HHA or hospice services;
3. The physician who bills CPO must be the same physician who signed the home health or hospice plan of care;
4. The physician furnishes at least 30 minutes of care plan oversight within the calendar month for which payment is claimed. Time spent by a physician's nurse or the time spent consulting with one's nurse is not countable towards the 30 minute threshold. Low intensity services included as part of other evaluation management services are not included as part of the 30 minutes requiring for coverage;
5. The work included in hospital discharge day management (codes 99238-99239) and discharge for observation (code 99217) is not countable towards the 30 minutes per month required for work on the same day as discharge but only for those services separately documented as occurring after the patient is actually physically discharged from the hospital;

6. The physician provided a covered physician service that required a face-to-face encounter with the beneficiary within the 6 months immediately preceding the first care plan oversight service in the ranges of codes 99201 - 99263 and codes 99281 - 99357 are acceptable prerequisite face-to-face encounters for CPO. EKG, lab, and surgical services are not sufficient face-to-face services for CPO;
7. The care plan oversight billed by the physician was not routine post-operative care provided in the global surgical period for a surgical procedure billed by the physician;

8. If the beneficiary is receiving home health agency services, the physician did not have a significant financial or contractual interest in the home health
agency. CPO services should not be billed by a physician who is an employee of the hospice, including a volunteer medical director. Payment for the services of a physician employed by the hospice are included in payment to the hospice;

9. The care plan oversight services are personally furnished by the physician who bills them;

10.Services provided incident to a physician's service do not qualify as CPO and do not count towards the 30- minute requirement;
11.The physician is not billing for the Medicare ESRD capitation payment for the same beneficiary during the same month; and
12.The physician billing the CPO must document in the patient's record which services were furnished and the date and length of time associated with those services.
Documentation
When a physician bills for HCPCS codes G0181 or G0182, he or she is stating that all the criteria have been met. The physician must maintain documentation that demonstrates that at all of the requirements for billing the code are met, including notations in medical records of the duration of telephone calls. Documentation supplied by home heath agencies or hospices may not be used in lieu of a physician's documentation. Only the physician who has signed the patient's plan of care may be paid for HCPCS codes G0181 and G0182.

Regina Answered Fri 14th of January, 2011 20:48:51 PM

When would you use 'G0180' & 'G0179'?

SuperCoder Answered Mon 17th of January, 2011 08:02:09 AM

Go to www.hgsa.com PA Medicare website. They have a lot of information that
might help you with the certification and recertification of HHS.

G0179 Recertification (every 60 days)
G0180 Initial Certification (only once)

You should use this code when an internist changes a home-health agency patient's treatment plan.

For instance, a patient isn't meeting the goals or levels that the physician set. So the home-health agency requests the internist reevaluate the patient's plan and change her medication. For a Medicare patient, you should report G0179, which Medicare covers monthly.

In order to bill for managing patients in home health care, you simply use code G0180 for initial certification, and G0179 for each follow up.

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