Wiki Re-certification for Medicare home health services

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ivygirl18@hotmail.com

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Hello,

I hope someone can help with some authoritative resources.

G0179 - Physician re-certification for Medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care that meets patient’s needs, per re-certification period

G0180 - Physician certification for Medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care that meets patient’s needs, per certification period.

What documentation is needed for providers to bill G0179 and G0180? If a Plan of Care/Certification is received from a home health agency and the provider is just signing the document the HHA prepared and then billing either G0179 or G0180, is this sufficient enough to support billing these codes? We think they need to be documenting more.

We have found information on our MAC website, but want to make sure we did not miss anything.
 
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The certifying physician’s and/or the acute/post-acute care facility’s medical record for the patient must contain information that justifies the referral for Medicare home health services. This includes documentation that substantiates the patient’s:
1. Need for the skilled services; and
2. Homebound status;
The certifying physician’s and/or the acute/post-acute care facility’s medical record for the patient must contain the actual clinical note for the face-to-face encounter visit that demonstrates that the encounter:
3. Occurred within the required timeframe,
4. Was related to the primary reason the patient requires home health services; and
5. Was performed by an allowed provider type.
This information can be found most often in, but is not limited to, clinical and progress notes and discharge summaries
 
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