EditaPetrosyan
Contributor
- Messages
- 19
- Location
- Yerevan, KT
I’m looking for clarification regarding New York State Medicaid billing for home care certification/recertification services performed via telehealth.
Are there any restrictions on billing a home care recertification when the certifying provider is not the patient’s PCP? The guidance I’ve reviewed appears to indicate that certification/recertification may be completed by a qualified clinician, but I have not found clear language requiring the provider to be the patient’s PCP.
For telehealth home care certification/recertification visits, do the standard physician/NP supervision requirements apply? For example, does the physician need to conduct the initial visit before an NP can perform follow-up recertifications, or can the NP independently perform and bill these services within their scope of practice?
Has anyone received guidance from NYS Medicaid, managed Medicaid plans, or experienced audits/denials related to home care certification or recertification completed virtually by a non-PCP provider?
Any policy references, billing guidance, or real-world experience would be greatly appreciated.
Thank you!
Are there any restrictions on billing a home care recertification when the certifying provider is not the patient’s PCP? The guidance I’ve reviewed appears to indicate that certification/recertification may be completed by a qualified clinician, but I have not found clear language requiring the provider to be the patient’s PCP.
For telehealth home care certification/recertification visits, do the standard physician/NP supervision requirements apply? For example, does the physician need to conduct the initial visit before an NP can perform follow-up recertifications, or can the NP independently perform and bill these services within their scope of practice?
Has anyone received guidance from NYS Medicaid, managed Medicaid plans, or experienced audits/denials related to home care certification or recertification completed virtually by a non-PCP provider?
Any policy references, billing guidance, or real-world experience would be greatly appreciated.
Thank you!