CPO-Cert-Recert-Presentation

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Flip the Switch OnFlip the Switch OnCare Plan Oversight Care Plan Oversight –– CertCert//RecertRecert

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Goals and Objectives

Understand The Concept of CPOKnow the difference between CPO and Certification/RecertificationMake the Information Physician SpecificSell The Idea to PhysiciansReap The Rewards

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Understand The Concept of CPO, Certification/Recertification

Physician

PLUS

Education

EQUALS

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What Codes are Used?

Effective January 1, 2001 HCPCS codes were added for physician services:

G0180 – Certification HHA patientG0179 – Recertification HHA patient

G0181 – Home Health Care Plan OversightG0182 – Hospice Care Plan Oversight

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Understand The Difference Between CPO and Cert/Recert

What is CPOHow does it work How to make it work for my agency

What is Cert/RecertHow does it work How to make it work for my agency

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What is Certification?G0180 MD Certification of HHA patient

Certification Billing Requirements

Must be billed by the physician that signed the patient’s Plan of CareUsed when a patient has not received Medicare covered home health services for at a least 60 daysCopy of Certification 485 in patient’s chart is sufficient documentation to support physician billingDate of service: Date the physician signs the POCBilled on Form HCFA-1500Locator 23: HHAs 6-digit Medicare provider number

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What is Recertification?G0179 MD Recertification of HHA patient

Recertification Billing Requirements

Must be billed by the physician that recertified the patient.Used after a patient has received Medicare covered home healthservices for at a least 60 days*Copy of Recertification 485 in patient’s chart is sufficient documentation to support physician billingDate of service: Date the physician signs the POCBilled on Form HCFA-1500Locator 23: HHAs 6-digit Medicare provider number

*The G0179 code will 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.

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What is CPO?

Care Plan Oversight (CPO) is physician supervision of patients under either the

home health (G0181) orhospice (G0182) benefit

the patient requires complex or multi-disciplinary care modalities requiring ongoing physician involvement.

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Requirements for CPOThe beneficiary must be receiving Medicare covered home health services during the period in which care plan oversight services are furnished.The physician must have provided a covered physician service that required a face to face encounter with the beneficiary in the 6 months before the first billing for care plan oversight services.

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Requirements for CPOThe beneficiary must require complex or multi-disciplinary care

•The physician must furnish at least 30 minutes of supervision within the calendar month for which payment is claimed and no other physician has been paid for CPO within that calendar month

The care plan oversight services must be personally provided by the physician who bills for the service

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Requirements for CPOBilling for CPO by surgeons must not be routine post-operative care provided in a global surgical periodPayment will be allowed for care plan oversight to physicians providing post surgical care during the post operative period only if the care plan oversight is documented to be unrelated to the surgery.The physician must NOT have a significant financial or contractual interest in the home health agencyThe physician is not the medical director or employee of the hospice, and does not provide services under an arrangement with the hospice

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Requirements for CPO

Services provided incident to office visits do not count towards the 30 minute requirementThe physician must not bill CPO during the same calendar month in which he/she bills ESRD benefit for the same patientThe physician billing CPO must document in the patient’s record which services were furnished, the date and length of time associated with those services (see sample log)

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Sample CPO Log for PhysicianPatient’s Name ______________________ Agency Name___________________

Physician Signature ________________________________________

minutesminutesminutesminutesminutesminutesminutesminutesminutesminutesminutesOther (define

minutesminutesminutesminutesminutesminutesminutesminutesminutesminutesMinutesAdjustment/Med Therapy

minutesminutesminutesminutesminutesminutesminutesminutesminutesminutesminutes

Integration of New Info-Treatment Plan

minutesminutesminutesminutesminutesminutesminutesminutesminutesminutesminutesComm w/Health Prof.

minutesminutesminutesminutesminutesminutesminutesminutesminutesminutesminutesDiag. Test Reviews

minutesminutesminutesminutesminutesminutesminutesminutesminutesminutesminutesLab Reviews

minutesminutesminutesminutesminutesminutesminutesminutesminutesminutesminutesReview of Pt. Records

minutesminutesminutesminutesminutesminutesminutesminutesminutesMinutesminutesRevision to Care Plan

minutesminutesminutesminutesminutesminutesminutesminutesminutesminutesminutesDevelopment of Care

TimeSub-totalDate (mm/dd/yyyy)

Total Time

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Requirements for CPOPhysician Documentation

Documentation must be done by the physician and not by the HHAAn agency’s provision of that service to a physician could be viewed as a kickbackintended to induce referrals.Billing must be done by the physician’s office staff and not by the HHA. (see Filing a Claim)

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CPO and Nurse Practitioners

Under the provisions of the BBA, nurse practitioners, physician assistants and clinical nurse specialists, practicing within the scope of State law, can bill for care plan oversight services.These non-physician practitioners must have been providing ongoing care for the patient through evaluation and management services provided as a physician service.If these practitioners are seeing the patient only for home health/hospice nursing visits, they may not bill for CPO.

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Countable Services

The following services are countable toward the 30 minute minimum for care plan oversight

Review of reports, orders, treatment plans, or lab or study results, except for the initial interpretation or review of lab or study results that were ordered during or associated with a face to face encounter.

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Countable Services

Telephone calls with other health care professionals involved in the care of the patientPhysician development and/or revision of care plansReview of subsequent reports of patient statusTeam conferences (Time spent per individual patient must be documented)

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Countable Services

Medical decision making: integration of new information into the

medical treatment planadjustment of medical therapy

Activities to coordinate services are countable if the coordination activities require the skills of a physicianTime spent working on a care plan after the nurse has conveyed pertinent information to the physician

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Non-Countable Services

Initial interpretation of lab or study results ordered during a face to face encounterPhysicians telephone calls to patient, family or pharmacy, even to adjust medication or treatment.

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Non-Countable Services

Travel time , time spent preparing claims or for claims processingLow intensity services included as part of other evaluation and management services

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Non-Countable Services

Informal consults with health professionals not involved with the patient’s care Time spent discussing the patient with office staff

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Filing a ClaimAll claims for CPO must contain the 6 digit Medicare provider number for the HHA or hospice rendering covered Medicare services during the period in which the care planning was furnished.

FORM 1500Item 23: Prior authorization number –HHA 6-digit Medicare provider numberItem 32: Facility where services were furnished –Physician’s office

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Filing a Claim

Dates of service entered on the claim form must be the first and last date during which documented care planning services were actually provided during the calendar month, not just the first and last days of the calendar month in which the claim is submitted

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Filing a Claim

Medical records for those dates must document that 30 minutes or more of time have been spent by physicians for countable care planning activities as well as which services were furnished and the date and length of time associated with those services

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Filing a Claim

The physician must bill for no other services than CPO services on the claim,must bill care planning only once per calendar month, must bill only one month’s services per line item and must not submit the claim until after the end of the month in which the service is performed

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Filing a Claim

Beneficiary LiabilityCPO is a Medicare Part B benefit

Medicare pays 80% of the fee schedule amount for physician services

Beneficiary is responsible for 20% coinsurance --either through supplemental insurance or out-of-pocket

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How do I make it work for my Agency?

Be willing to invest the time to provide the education to physician offices

Start with your biggest referring physician Follow the physicians case loadCompile notes and documentation from a sample of the physicians patient base

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How do I make it work for me? Prepare an Educational Packet

Track documentation per physicianPrepare spread sheet per physicianCompile a sample month for that physician on a spreadsheet using his own patients and numbersPut together a presentation per physician that includes brief instruction, his patient’s documentation and his spread sheet showing the bottom line

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It will work!

Sell the idea to the physiciansMake an appointment to talk directly to the physician and/or billing staffPresent him with a brief overview of home care criteriaPresent him with the fact that he is able to bill for home care services and a very brief outline of how

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It will work!

Use Physician’s own numbers in your favorProvide a sample log for the physician’s use in documenting timeOffer to instruct staff in billing proceduresOffer to send a current list of patients every month

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Reap the rewards

Increased referrals

Add Up to

Increased profitsFor YOU!!