Flip the Switch On Care Plan Oversight - Cert

1. Flip the Switch OnCare Plan Oversight - Cert/Recert

2. Goals and Objectives Understand The Concept of CPO Know the difference between CPO and Certification/Recertification Make the Information Physician Specific Sell The Idea to Physicians Reap The Rewards

3. Understand The Concept of CPO, Certification/Recertification

4. What Codes are Used? Effective January 1, 2001 HCPCS codes were added for physician services: G0180 � Certification HHA patient G0179 � Recertification HHA patient G0181 � Home Health Care Plan Oversight G0182 � Hospice Care Plan Oversight

5. Understand The Difference Between CPO and Cert/Recert What is CPO How does it work How to make it work for my agency What is Cert/Recert How does it work How to make it work for my agency

6. 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 Care Used when a patient has not received Medicare covered home health services for at a least 60 days Copy of Certification 485 in patient�s chart is sufficient documentation to support physician billing Date of service: Date the physician signs the POC Billed on Form HCFA-1500 Locator 23: HHAs 6-digit Medicare provider number

7. 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 health services for at a least 60 days* Copy of Recertification 485 in patient�s chart is sufficient documentation to support physician billing Date of service: Date the physician signs the POC Billed on Form HCFA-1500 Locator 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.

8. What is CPO? Care Plan Oversight (CPO) is physician supervision of patients under either the home health (G0181) or hospice (G0182) benefit the patient requires complex or multi-disciplinary care modalities requiring ongoing physician involvement.

9. Requirements for CPO The 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.

10. Requirements for CPO The beneficiary must require complex or multi-disciplinary car 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

11. Requirements for CPO Billing for CPO by surgeons must not be routine post-operative care provided in a global surgical period Payment 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 agency The physician is not the medical director or employee of the hospice, and does not provide services under an arrangement with the hospice

12. Requirements for CPO Services provided incident to office visits do not count towards the 30 minute requirement The physician must not bill CPO during the same calendar month in which he/she bills ESRD benefit for the same patient The 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)

13. Sample CPO Log for PhysicianPatient�s Name ______________________ Agency Name___________________Physician Signature ________________________________________

14. Requirements for CPOPhysician Documentation Documentation must be done by the physician and not by the HHA An agency�s provision of that service to a physician could be viewed as a kickback intended to induce referrals. Billing must be done by the physician�s office staff and not by the HHA. (see Filing a Claim)

15. 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.

16. 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.

17. Countable Services Telephone calls with other health care professionals involved in the care of the patient Physician development and/or revision of care plans Review of subsequent reports of patient status Team conferences (Time spent per individual patient must be documented)

18. Countable Services Medical decision making: integration of new information into the medical treatment plan adjustment of medical therapy Activities to coordinate services are countable if the coordination activities require the skills of a physician Time spent working on a care plan after the nurse has conveyed pertinent information to the physician

19. Non-Countable Services Initial interpretation of lab or study results ordered during a face to face encounter Physicians telephone calls to patient, family or pharmacy, even to adjust medication or treatment.

20. Non-Countable Services Travel time , time spent preparing claims or for claims processing Low intensity services included as part of other evaluation and management services

21. Non-Countable Services Informal consults with health professionals not involved with the patient�s care Time spent discussing the patient with office staff

22. Filing a Claim All 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 1500 Item 23: Prior authorization number � HHA 6-digit Medicare provider number Item 32: Facility where services were furnished � Physician�s office

23. 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

24. 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

25. 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

26. Filing a Claim Beneficiary Liability CPO 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

27. How do I make it workfor 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 load Compile notes and documentation from a sample of the physicians patient base

28. How do I make it work for me? Prepare an Educational Packet Track documentation per physician Prepare spread sheet per physician Compile a sample month for that physician on a spreadsheet using his own patients and numbers Put together a presentation per physician that includes brief instruction, his patient�s documentation and his spread sheet showing the bottom line

29. It will work! Sell the idea to the physicians Make an appointment to talk directly to the physician and/or billing staff Present him with a brief overview of home care criteria Present him with the fact that he is able to bill for home care services and a very brief outline of how

30. It will work! Use Physician�s own numbers in your favor Provide a sample log for the physician�s use in documenting time Offer to instruct staff in billing procedures Offer to send a current list of patients every month

31. Reap the rewards