Medicare Now Reimburses Ordering Plans of Care for Home Health Patients
Published on Fri Jun 01, 2001
Effective Jan. 1, 2001, HCFA began reimbursing gastroenterologists for doing something they may have already been doing certifying and recertifying plans of care for home healthcare patients. Many gastroenterologists have put off billing for these services because they just didnt believe that HCFA would offer them a new source of revenue.
HCFA has established the following HCPCS codes for reporting certification and recertification services after the Jan. 1, 2001, effective date:
G0180 physician certification services for Medicare-covered services provided by a participating home health agency (patient not present), including review of initial or subsequent reports of patient status, review of patients responses to the Oasis assessment instrument, contact with the home health agency to ascertain the initial implementation plan of care, and documentation in the patients office record, per certification period.
G0179 MD recertification, HHA patient
The ordering of home health services is nothing new, says Kathy Pride, CPC, coding supervisor for Martin Memorial Medical Group in Stuart, Fla. Most physicians ask me if Im sure this is legal. It sounds too good to be true, but it is.
HCFA is using the HCPCS codes to entice gastroenterologists and other physicians to give more time and thought to home healthcare plans, according to Brett Baker, third party relations specialist at the American Society of Internal Medicine in Washington, D.C.
Because there are lots of time constraints and paperwork involved in the prescribing of these services, HCFA believes that some physicians have only been giving the plans cursory attention.
Another reason why gastroenterologists have been reluctant to bill these codes is because there has been a lack of information on how they should be used. The problem is that there has been very little information in the Federal Register about how to use these codes, Baker says. The carriers have been slow on getting information out because they are waiting for instructions from HCFA, and information from HCFA is just trickling out.
Use G0180 for Certification of Plan
The initial certification code, G0180, which has a transitioned nonfacility relative value unit (RVU) of 1.91, should be reported when a patient has not received Medicare-covered home health services for at least 60 days. This certification only applies when the services of a Medicare covered home health agency are prescribed, Pride explains. These agencies provide nursing, as well as some housekeeping to homebound patients. These services literally have to be in the patients private residence, she says. Also, the patient has to be truly homebound. He or she cannot be able drive to the physicians office for a visit.
An example of a patient for whom home health service might be prescribed is someone with a severe and chronic [...]
