Documenting and Billing for Care Plan Oversight

Home Health & Hospice

There is one service that is not face-to-face that physicians can be reimbursed for by Medicare—care plan oversight (CPO) of patients receiving home health or hospice.  Because the rules are complicated, many physicians simply don’t bill for this service.  Here we’ll try to break it down.  
To bill, CPO services must take at least 30 minutes in a calendar month. The services do not need to be provided on the same day, but the total services over the course of a month must add up to at least half an hour.  Medicare uses two HCPCS codes to pay for CPO:  G0181 is for home health, and G0182 is for hospice. 

YOU CAN BILL FOR TIME SPENT:

• Reviewing charts, reports and treatment plans
• Reviewing diagnostic studies that weren’t associated with a face-to-face encounter
• Phone calls with other health care professionals involved in the patient’s care who are not employees of the practice
• Conducting team conferences
• Discussing drug treatment and interactions (not routine prescription renewals) with a pharmacist
• Coordinating care if physician or non-physician practitioner time is required
• Making and implementing changes to the treatment plan

YOU MAY NOT BILL FOR THE TIME YOU SPEND:

• Renewing prescriptions
• Talking with fellow employees at the practice
• Travel time
• Preparing or submitting claims
• Talking to the patient’s family, even if discussing treatment plan changes
• Holding informal consults with physicians who are not treating the patient
• Working on discharge services
• Interpreting test results at an E/M visit

GOOD HABITS

• Keep a log of the patients you provide CPO to; use this as a reminder to pull those charts at the end of the month. 
• Keep a simple CPO log in each of these charts and document the date, total time and a brief description of the services as you provide.  Sign this documentation.
• At month end gather the logs, total the time and bill for those for whom you provided at least 30 minutes of CPO.  Put the beginning and end dates of the month as the dates of service and be sure to put the provider number of the home health agency or hospice on the claim form.

For more information or questions, or to receive written materials about billing for care plan oversight, call Kaye Holbrook at 408.773.4359 or email your request to kholbrook@pathwayshealth.org.

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 24.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.