Care Plan Oversight

can anyone direct me to instructions on billing the G0181 code to medicare part B. I have never billed for this and have been denied. thank you

re: Care Plan Oversight

what was the denial reason?

re: Care Plan Oversight

I'm asking what the denial reason is, because I bill G0180 for a new certification and G0179 for a recertification, and both get paid. The doctor I bill for sees patients in nursing homes and a facility is listed on the claim. Maybe you didn't have a facility listed?

re: Care Plan Oversight

I am no pro, but I do know a little about Care plan oversight. You bill for the time spent PER MONTH. This is a once per month billing. G0181 is for up to 30 minutes TOTAL per month, G0182 is for 30 minutes or more per month.

That is all I really know, but I hope it helps!

re: Care Plan Oversight

Yes, blm321 is correct, the recertifications I see usually last two months.

re: Care Plan Oversight

First I really didn't know what I was doing and still don't. We bill the certificates G0180 new and G0179 recerts with no problems. The Dr. said he wants to be reimbursed for all the time during the months of the certificate period for all the extra time he spends coordinating care. he was told that we could bill for that.
The first time I billed I used the 99339 code which he gave me and the diagnosis he gave me and using the office as the place of service and the dos was the day the date he completed his notes. Since found that was the wrong procedure code.
I billed another patient with the G0181 and used the same diagnosis in the same order that is on the certificate used the POS for the office and the dates he accumulated the time. He said it was from 4/2 to 4/30. I have spoken several times to the medicare reps and they will not tell me exactly what is wrong. One told me it was part of the Part A service and I should bill the home health agency.
Can anyone tell me the correct format for billing this G0181 code, am I to use the diagnosis on the certificate he signed. What date of service do I use? thank you

re: Care Plan Oversight

I have always billed using the date "start of care" on the certificate, and for recert, the date beginning "recert period." I have not heard of billing for the entire month, it has always been just the one date on the plan of care.

re: Care Plan Oversight

I found this online: Physicians can bill for 30 minutes of Care Plan Oversight that includes supervision of a complicated patient and requires extensive review /revision of care plans, review of laboratory or study results, phone calls to other health professionals, and other activities associated with the patient’s home health care.

CHECKLIST OF CARE PLAN OVERSIGHT REQUIREMENTS

If your situation meets all the requirements listed below, you are eligible to bill for your services:

?The physician cannot have a significant financial arrangement with the home health agency or hospice that is providing care to the patient.


?The physician may not be an employee or medical director of the home health agency or hospice.


?Only one physician per month may bill CPO.


?Neither a physician who is billing for the end-stage renal disease services under a capitation arrangement nor a physician who is providing surgical follow-up in the global period may bill for CPO.


?The physician who bills for the CPO must be the same physician who signed the certification for the home health agency or hospice in the first place.


?The physician must have had a face-to-face service with the patient within six months of billing for the CPO.


?The physician must have personally provided at least 30 minutes of service in one calendar month.


?The beneficiary must be receiving Medicare covered home health or hospice services during the period in which CPO is billed.


?The beneficiary must require complex or multidisciplinary care modalities requiring ongoing physician involvement in the patient's plan of care.

hope this helps?

re: Care Plan Oversight

REGINA1975, Yes that helps, thank you and thank you to the others who responded to this question.