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Reimbursement Opportunities for the Oversight of Home Health Services
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Pdf Summary
This resource outlines the reimbursement opportunities for care plan oversight (CPO) of home health and hospice services by qualified healthcare professionals, such as physicians, nurse practitioners (NPs), and physician assistants (PAs). This review helps healthcare practices optimize their billing models by ensuring they are compensated for the care oversight they provide.<br /><br />### Home Health Services:<br /><br />**Billing Codes:**<br />- **G0180**: For certifying the plan of care at the start of home health services.<br />- **G0179**: For recertifying the plan of care every 60 days.<br /><br />**Eligibility and Requirements:**<br />- Effective from March 1, 2020, NPs, CNSs, and PAs can bill for these services under the CARES Act.<br />- Documentation must include the date the plan is reviewed and signed, evidence of communication with the home health agency, and review of patient status.<br /><br />### Care Plan Oversight (CPO) Services:<br /><br />CPO entails the clinician's supervision of patients receiving home health or hospice services requiring complex or multidisciplinary care. The minimum time spent on CPO activities should be 30 minutes per month.<br /><br />**Billable Activities:**<br />- Development and revision of care plans<br />- Review of patient status and related tests<br />- Communication with healthcare professionals not in the same practice<br />- Integration of new information and adjustment of therapy<br /><br />**Non-Billable Activities:**<br />- Patient or family discussions<br />- Time spent by staff on non-clinical tasks<br />- Travel time<br /><br />**Billing Codes:**<br />- **G0181**: Monthly CPO for home health services.<br />- **G0182**: Monthly CPO for hospice services (currently billable only by physicians).<br /><br />### Documentation Requirements:<br /><br />- Ensure detailed and specific documentation of clinical activities<br />- Provide exact times spent on each service date<br />- Maintain records of all communications and adjustments in treatment plans<br /><br />### Limitations:<br /><br />- CPO services cannot be billed in the same month as Chronic Care Management (CCM) services; practices must choose the most suitable billing option.<br />- CPO cannot be billed for patients in skilled nursing facilities.<br />- Claims must reflect calendar month timelines and meet detailed documentation standards, including evidence of recent face-to-face E/M services within six months of CPO billing.<br /><br />This guide ensures that clinicians maintain compliance while effectively capturing reimbursement opportunities for the oversight of home health and hospice services.
Keywords
reimbursement
care plan oversight
home health services
hospice services
billing codes
physicians
nurse practitioners
physician assistants
documentation requirements
CARES Act
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