Physicians may submit claims for care plan oversight services to those patients that qualify.
(Patients with complex multi-disciplinary care needs requiring 30 minutes or more of care plan oversight within a calendar month)

Conditions for Payment for Care Plan Oversight

• The services are furnished to beneficiaries receiving Medicare covered home health and hospice services
• Physician has furnished a service requiring face-to-face encounter with the patient in the six months before the first billing for CPO.
• Physicians must not have ties to the Home Health Agency.

Standards for Payment

• Payment will be allowed to only one physician per month for recurrent physician oversight involving 30 or more minutes of the physician's time per month.
• Payment allowed for post-surgical care only if CPO is to be unrelated to the surgery.
• Payment allowed during 30 days following hospital discharge.

Coding for Claim

• Home Health Care Plan Oversight Code: G0181
• Hospice Care Plan Oversight Code: G0182

Filing a Claim

• Nothing except CPO is to be billed on the claim.
• Claims only billed once per calendar month.
• Claims submitted after end of month services are performed.
• Date of service must be exact!
• Medical records must document the 30 minutes of oversight, including date and times.
• Appropriate codes must be used (see Coding For Claim section above).
• All claims must contain the 6-digit Medicare Provider number of the Home Health Agency or Hospice.
• Claims must be completed and submitted by the physician's office staff. The Home Health Agency or Hospice can not submit the claims.

Common Mistakes

• The Home Health Agency 6-Digit Medicare provider number. (Item 23 on Form 1500)
• Physician's Office (Items 32 & 33 on Form 1500)

Examples of Included Services

• Ongoing review of reports, orders, treatment plans, changes in status, lab results, etc.
• Phone calls with other involved in patient's care.
• Development/Revision of care plan.
• Treatment team conferences.
• Medical decision making
• Coordination of services.

Examples of Non-Included Services

• Time spent discussing patient with office staff.
• Travel time, time spent on processing claims.
• Phone calls to patient, family, pharmacy
• Services provided incident to office visits.
• Initial interpretation of lab results ordered during a face to face encounter.

Issues/Concerns

• Documentation
• Beneficiary Co-Pay
• Medicare Only
• Calendar Month Basis
• Face-To-Face Evaluation
• Interface with Home Health Agency
• Nurses, P.A.s, Clinical Nurse Specialists
• Time with patient or family excluded
• Reimbursement Rate