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Physician Reimbursement: Are you taking full advantage?...

Log into Physician's Portal It is estimated that each year physicians are not collecting millions of dollars worth of care plan oversight payments for their work with Medicare-eligible home health patients.

Frequently Asked Questions

What is the reimbursement rate for this service?

HHA Code G0179 G0180 G0181
Arizona 41.55 54.04 108.39
California 43.78 56.65 112.75
Fort Lauderdale, FL 43.19 56.4 112.99
Suburban Chicago, IL 43.96 57.31 114.58
Chicago, IL 43.94 57.53 115.48
Rest of Illinois 39.73 52.13 105.99
Indiana 39.94 51.33 103.99
Metropolitan Boston 45.53 58.61 115.39
Rest of Massachusetts 43.16 55.85 111.24
Minnesota 41.44 53.6 107.04
Nevada 42.99 55.8 111.3
Ohio 39.67 51.92 105.34
Pennsylvania 39.93 52.22 105.79
Dallas, TX 41.95 54.54 109.48
Fort Worth, TX 41.4 53.83 108.07
Houston, TX 42.09 54.81 110.14
Rest of Texas 39.54 51.67 104.75

For areas other than listed above please click here or contact your marketer.
Please direct questions to David Pratt 317-334-7777 . We are also available to provide an in-service to your billing staff.

What is certification/recertification?
Certification is signing the plan of care commonly known as the "485." Recertification is signing the plan of care when a patient needs subsequent episodes of care that run consecutively.

What is the certification period?
Each episode of home health or hospice care is a period of 60 days. If a patient requires continued services, a recertification is required.

What is Care Plan Oversight and give some examples?
Care plan oversight services might include ongoing review of reports, orders, or lab/study results for example. Services not included are initial interpretation of lab/study results, telephone calls to the patient, family, or pharmacy even to adjust medication or treatment. For more comprehensive information regarding allowable oversight services, you can visit the CMS website at www.cms.gov or the National Association of Home Care at www.nahc.org.

What are the documentation requirements?
Each care plan oversight activity must be documented in the patient's chart including the amount of time associated with it. The documentation is not required to accompany the claim submitted to Medicare, but must be available should the intermediary request it.

What codes for HHA Billing do I need to fill in?
The Codes for HHA Billing are to be filled in on Item #24.D of CMS Form 1500 are as follows:
GO179 – HHA Re-Certification
GO180 – HHA Initial Certification
GO181 – Home Health Care Supervision
It is important to put the HHA Medicare Provider # in Item #23. The Patient Advocate who signs you up will make the Provider number of our local office available to you.

Can I bill for care plan oversight if I have already been reimbursed for certification?
Yes. Physicians are eligible for potential reimbursement for all Medicare-eligible home health or hospice patients. Care plan oversight is a billable service in addition to certifying the plan of care.

The National Association for Home Care is hopeful that the recognition of the physician's involvement in these services as reimbursable activities will ultimately enhance the level of care for home health and hospice patients in addition to providing adequate reimbursement to physicians for their time devoted to the care and needs of their patients.

Please direct questions to David Pratt 317-334-7777 . Nightingale is also available to provide an in-service to your billing staff.