Care Plan Oversight for Physicians
Physician Reimbursement: Are you taking full advantage?
It is estimated that each year physicians are not collecting millions of dollars
worth of care plan oversight payments for their work with Medicare-eligible home
health patients.
Frequently Asked Questions
What is the reimbursement rate for this service?
- The initial certification is reimbursed at: $71.05
- Recertification reimbursement: $54.21
- Care Plan Oversight for Home Health: $120.48
- Care Plan Oversight for Hospice: $126.85
What is certification/recertification?
- Certification is signing the plan of care commonly known as the "485." Recertification
is signing the plan of care when a patient needs subsequent episodes of care that
run consecutively.
What is the certification period?
- Each episode of home health or hospice care is a period of 60 days. If a patient
requires continued services, a recertification is required.
What is Care Plan Oversight and give some examples?
- Care plan oversight services might include ongoing review of reports, orders, or
lab/study results for example. Services not included are initial interpretation
of lab/study results, telephone calls to the patient, family, or pharmacy even to
adjust medication or treatment. For more comprehensive information regarding allowable
oversight services, you can visit the CMS website at www.cms.gov or the National
Association of Home Care at
www.nahc.org.
What are the documentation requirements?
- Each care plan oversight activity must be documented in the patient’s chart including
the amount of time associated with it. The documentation is not required to accompany
the claim submitted to Medicare, but must be available should the intermediary request
it.
Do I have to bill on a special claim form?
- No. Certification and care plan oversight services are billed to Medicare Part B
on the HCFA 1500 bill form currently used to bill all other physician services.
Can I bill for care plan oversight if I have already been reimbursed for certification?
- Yes. Physicians are eligible for potential reimbursement for all Medicare-eligible
home health or hospice patients. Care plan oversight is a billable service in addition
to certifying the plan of care.
The National Association for Home Care is hopeful that the recognition of the physician’s
involvement in these services as reimbursable activities will ultimately enhance
the level of care for home health and hospice patients in addition to providing
adequate reimbursement to physicians for their time devoted to the care and needs
of their patients.
Please direct questions to Valerie Perout at 330-861-6102. VNS is also
available to provide an in-service to your billing staff.