OASIS Alert

Published on Fri Mar 26, 2004 PDF

Agencies may find doctors questioning them about why the Part B Carrier isn't paying the doc for certifying and recertifying home health plans of care.

According to the National Association for Home Care and Hospice, doctors are having trouble gettting paid in three circumstances:

1. Carriers tell physicians to use the date of the verbal order or the date the home plan of care is signed. Instead, carriers should tell them to use the 'from' date on the home health POC, NAHC tells the Centers for Medicare & Medicaid Services in a letter requesting action on the physician payment issue.

If not, claims are denied when the date isn't within the patient's home health episode or if it ap-pears the physician is billing for more than one cert/recert in a 60-day period.

2. Carriers require a copy of the POC with every physician cert/recert claim. "This requirement is analogous to subjecting physicians to 100 percent prepayment review," NAHC objects. Carriers should limit review to problem providers.

3. Carriers deny cert/recert claims if the only documentation submitted is the POC. A final rule on the payment defines the service as "when the physician signs the certification," so POCs should be sufficient evidence, NAHC urges.