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CPO-Cert-Recert-Presentation

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  • 1. Flip the Switch OnCare Plan Oversight – Cert/Recert 1
  • 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 2
  • 3. Understand The Concept ofCPO, Certification/Recertification Physician PLUS Education EQUALS 3
  • 4. What Codes are Used?Effective January 1, 2001 HCPCS codeswere added for physician services: G0180 – Certification HHA patient G0179 – Recertification HHA patient G0181 – Home Health Care Plan Oversight G0182 – Hospice Care Plan Oversight 4
  • 5. Understand The Difference Between CPO and Cert/RecertWhat is CPO What is Cert/RecertHow does it work How does it workHow to make it How to make itwork for my work for myagency agency 5
  • 6. What is Certification? G0180 MD Certification of HHA patientCertification 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 6
  • 7. What is Recertification? G0179 MD Recertification of HHA patient Recertification Billing RequirementsMust 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. 7
  • 8. What is CPO?Care Plan Oversight (CPO) is physiciansupervision of patients under either the home health (G0181) or hospice (G0182) benefitthe patient requires complex or multi-disciplinary care modalities requiringongoing physician involvement. 8
  • 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. 9
  • 10. 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 monthThe care plan oversight services must bepersonally provided by the physician who billsfor the service 10
  • 11. 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 tophysicians providing post surgical care during the postoperative period only if the care plan oversight isdocumented to be unrelated to the surgery.The physician must NOT have a significant financial orcontractual interest in the home health agencyThe physician is not the medical director or employee ofthe hospice, and does not provide services under anarrangement with the hospice 11
  • 12. Requirements for CPOServices provided incident to office visits do notcount towards the 30 minute requirementThe physician must not bill CPO during the samecalendar month in which he/she bills ESRD benefitfor the same patientThe physician billing CPO must document in thepatient’s record which services were furnished,the date and length of time associated with thoseservices (see sample log) 12
  • 13. Sample CPO Log for Physician Patient’s Name ______________________ Agency Name___________________ Physician Signature ________________________________________ Sub- TimeDate (mm/dd/yyyy) totalDevelopment of Care minutes minutes minutes minutes minutes minutes minutes minutes minutes minutes minutesRevision to Care Plan minutes Minutes minutes minutes minutes minutes minutes minutes minutes minutes minutesReview of Pt. Records minutes minutes minutes minutes minutes minutes minutes minutes minutes minutes minutesLab Reviews minutes minutes minutes minutes minutes minutes minutes minutes minutes minutes minutesDiag. Test Reviews minutes minutes minutes minutes minutes minutes minutes minutes minutes minutes minutesComm w/Health Prof. minutes minutes minutes minutes minutes minutes minutes minutes minutes minutes minutesIntegration of New Info-Treatment Plan minutes minutes minutes minutes minutes minutes minutes minutes minutes minutes minutesAdjustment/Med Therapy Minutes minutes minutes minutes minutes minutes minutes minutes minutes minutes minutesOther (define minutes minutes minutes minutes minutes minutes minutes minutes minutes minutes minutes Total Time 13
  • 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) 14
  • 15. CPO and Nurse PractitionersUnder the provisions of the BBA, nurse practitioners,physician assistants and clinical nurse specialists,practicing within the scope of State law, can bill forcare plan oversight services.These non-physician practitioners must have beenproviding ongoing care for the patient throughevaluation and management services provided asa physician service.If these practitioners are seeing the patient only forhome health/hospice nursing visits, they may not billfor CPO. 15
  • 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. 16
  • 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) 17
  • 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 18
  • 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. 19
  • 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 20
  • 21. Non-Countable Services Informal consults with health professionals not involved with the patient’s care Time spent discussing the patient with office staff 21
  • 22. Filing a ClaimAll claims for CPO must contain the 6 digitMedicare provider number for the HHA orhospice rendering covered Medicare servicesduring the period in which the care planning wasfurnished. FORM 1500Item 23: Prior authorization number –HHA 6-digit Medicare provider numberItem 32: Facility where services were furnished –Physician’s office 22
  • 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 23
  • 24. Filing a ClaimMedical records for those dates mustdocument that 30 minutes or more oftime have been spent by physicians forcountable care planning activities aswell as which services were furnishedand the date and length of timeassociated with those services 24
  • 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 25
  • 26. Filing a ClaimBeneficiary 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 26
  • 27. How do I make it work for my Agency?Be willing to invest the time to providethe 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 27
  • 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 28
  • 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 29
  • 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 30
  • 31. Reap the rewards Increased referralsAdd Up to Increased profits For YOU!! 31

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