Wiki G0179 with multiple home health agencies

[TrachDad]

Hello everyone. I'm relatively new to billing home health certs/re-certs, and I have a question regarding billing G0179 when a patient has multiple home health agencies that I haven't seen answered in other threads on this code (if I missed it please let me know).

We have a pt with multiple agencies that have overlapping certification period dates for the plan of care. So, the physician wants to bill for re-certification for agency #2 but had just bill for re-certification for agency #1 less than two weeks prior.

Reading the guidelines I've seen nothing indicating to me that G0179 would be a per-agency code, in other words I'm thinking that it can only be billed once in 60 days regardless of however many agencies are involved in the patient's care and need plans of care signed. However, I'm not 100% sure about this so I have to ask: can G0179 be billed for each agency's recertification even though the bills would fall within 60 days of each other, or is it just a once per 60 day billing code regardless of the number of agencies involved in the patient's care?

Thanks in advance for any responses.

 

[thomas7331]

You're correct - in my experience, Medicare will only reimburse this code once per patient per certification period. In fact, I think that if there are multiple agencies involved, there will likely be a problem on with the agencies getting reimbursed as well - do you know if these two agencies are aware that another agency is also providing care? I've not actually encountered this situation, but I don't think Medicare will allow this. There should only be one agency involved in coordinating and providing home care at any given time. If that one agency cannot provide all of the services required, my understanding is that they would be responsible for contracting with other providers to obtain those services, and then billing all services on a single consolidated bill.

 

[TrachDad]

You're correct - in my experience, Medicare will only reimburse this code once per patient per certification period. In fact, I think that if there are multiple agencies involved, there will likely be a problem on with the agencies getting reimbursed as well - do you know if these two agencies are aware that another agency is also providing care? I've not actually encountered this situation, but I don't think Medicare will allow this. There should only be one agency involved in coordinating and providing home care at any given time. If that one agency cannot provide all of the services required, my understanding is that they would be responsible for contracting with other providers to obtain those services, and then billing all services on a single consolidated bill.

Thank you for your response. It is the only case I have encounter with this situation so far. From a patient perspective I know what it is like to have multiple home nursing agencies involved in treatment under Medicaid rather than Medicare, but I have not previously encountered a multiple-agency case in my work until now. At this point I don't know how the financials are worked out between the two agencies in this case.

 

[thomas7331]

Thank you for your response. It is the only case I have encounter with this situation so far. From a patient perspective I know what it is like to have multiple home nursing agencies involved in treatment under Medicaid rather than Medicare, but I have not previously encountered a multiple-agency case in my work until now. At this point I don't know how the financials are worked out between the two agencies in this case.

From the certifying provider's perspective, there should only be a need for one certification per 60 days in any case. If the patient changes agencies of otherwise gets care from a new agency, that original certification should still be in effect and would still apply. I would think that a copy of the first certification could be sent to the new agency to use - there shouldn't be a need for the provider to do a new certification again until the 60-day period expires.