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Part B Insider (Multispecialty) Coding Alert

Physician Notes:

NPPs Can Bill For Care Plan Oversight, CMS Clarifies

Published on Tue Sep 07, 2004 Print Friendly and PDF PDF

Starting next year, your non-physician practitioner staff can keep track of home health care plans and receive payment from Medicare.
 
CMS Rule Were Contradicting

In the past, Medicare rules on NPPs billing for care plan oversight (G0181) were an unruly tangle. On the one hand, a 1997 law said NPPs could bill for home care oversight as long as they practiced within their states' laws. On the other hand, the Centers for Medicare & Medicaid Services had decreed that only the provider who certified home care services could bill for CPO.
 
Future: More Practices Can Bill

Now, CMS has clarified in the proposed physician fee schedule that NPPs can bill for CPO even if they didn't certify the patient. This means physicians will have access to a "physician extender" who can help make their lives easier, notes Camden, SC surgeon M. Trayser Dunaway.
 
Because CPO requires stringent time-keeping, the change means more practices can bill for more patients under CPO, and thus increase their Medicare reimbursement, notes Mike Ferris of Home Care Marketing Solutions in Chapel Hill, NC.
 
In Other News...

 

  • The loss of the 90 day grace period for new codes should serve as a wake-up call for practices that have been lagging, say experts.
     
    Larger practices will stay up to date with CPT and ICD-9 codes, but smaller practices are perennially behind, says consultant W. Robert Cooper with W. Robert Cooper Associates in Peoria, IL. Many small practices will say, "I don't want to spend the $400 for a CPT book. I did that last year," he notes. Only when they get back Explanation of Benefits forms for denied claims do they think twice. He hopes the shorter timeframe will spur more practices to be aware of the need to update.
     
    Practices "used to be able to put their heads in the sand," says Jeff Eckert, president of Medico Unlimited in Overland Park, KS. They would have insufficient staff, and deal with problems by appealing claims denials and "put out fires as they arise. You can't do it any more," says Eckert.
     
     
  • Lebanon, OH physician Kyle Howard received a search warrant after he claimed to treat between 40 and 70 patients per day during office hours. And now the doctor faces indictment and a potential five-year prison sentence, plus a $10,000 fine and restitution.
     
    "If Dr. Howard spent an average of twenty-five minutes with each patient, he would have only been able to see approximately fifteen patients on a daily basis," Attorney General Jim Petro said.

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