American College of Physicians: Internal Medicine — Doctors for Adults ®

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Medicare changes some rules on home health billing

From the March 2001 ACP-ASIM Observer, copyright 2001 by the American College of Physicians-American Society of Internal Medicine.

By Brett Baker

Q: Does Medicare now pay a separate fee to certify and recertify a home health care plan? How do I bill for these services?

A: As of Jan. 1, 2000, Medicare began paying physicians a separate fee for activities involved in certifying and recertifying a patient’s home health care plan.

You must use the following HCFA Common Procedure Coding System (HCPCS) codes to bill for these services:

  • Use G0180 when certifying physician services for Medicare-covered services provided by a participating home health agency (where the patient is not present). This includes reviewing initial or subsequent reports of patient status, reviewing patient responses to an OASIS assessment, contacting the home health agency to ascertain the initial implementation of the care plan, and documentation in the patient's office record, per certification period.

  • Use G0179 when recertifying home health agency patients.

The initial certification code, G0180, must be used when patients have not received Medicare-covered home health services for at least 60 days. The recertification code, G0179, must be used when patients have received covered home health services for at least 60 days, and when the physician signs the certification after the initial certification.

Q: What do I need to document in the patient medical record to justify these services?

A: You should describe in the patient record those activities involved in deciding whether the home health care plan is appropriate or if the proposed care plan needs to be modified to better meet the beneficiary's needs. As a precaution, keep a copy of the approved care plan in the record.

Medicare does not require physicians to submit medical record documentation with the claim for these services. You should, however, be able to provide the supporting documentation if requested.

Q: What does Medicare pay for these services?

A: Medicare pays $73.08 for physician certification of a patient care plan (G0180) and $61.23 for recertification (G0179). These payment rates represent the national average. Payments vary slightly by geographic area.

Medicare previously did not provide separate reimbursement for certifying or recertifying a patient’s care plan. Because these services were included in the 2001 Medicare physician fee schedule, physicians can be paid for services that they could not bill separately in the past.

Q: By establishing these new G codes, has Medicare made it harder for me to meet the 30-minute requirement to bill for care plan oversight of a home health patient?

A: Physicians can no longer count time spent approving/revising a patient home health care plan as part of the 30-minute requirement of billing care plan oversight for a beneficiary’s home health services if it relates to certification or recertification. (Spending 30 minutes or more on care plan oversight of a home health patient should be reported using G0181.) HCFA allowed physicians to count time spent on certification or recertification before it initiated separate payment for these activities on January 1, 2001.

“CPT 2001 updates evaluation and management codes” (January 2001 ACP-ASIM Observer, page 5) contains information on HCFA’s requirement that physicians use G0181 to bill for oversight services for home health patients and G0182 for oversight services for hospice patients.

Brett Baker is a third-party payment specialist in the College’s Washington Office.

If you have questions about third-party payment or coding issues, contact him at 202-261-4533 or bbaker@acponline.org.

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