Physician Reimbursement for Home Health Certification

What do they mean by “certification”?

For each patient, a physician must sign a new plan of care at admission and every 60 days thereafter. AbleCare types the plans of care on a form called the CMS 485. On this form, the physician certifies that the patient needs nursing or therapy.

Are You Leaving Money on the Table?

Are you sure that your office receives full reimbursement for reviewing and signing plans of care? AbleCare Home Health has received billing questions from physicians recently, and we wanted to make sure our valued physicians were fully aware of the three ways they can get paid for what they do.

Some physicians choose to forgo the Home Health Care Plan Oversight billing because of the documentation requirements. However, all physicians (and their billing staff) should know that other codes for Certification and Recertification can be documented and billed more easily. Any time a physician signs a Medicare plan of care (the CMS 485), the physician can bill for that service. For documentation of certifications, simply save a copy of the signed plan of care.

If you are not sure whether you have billed for all your home health plans of care, AbleCare Home Health can help by sending you a copy of every plan of care you have certified in the past 12 months. Call (877) 236-2220. As always, the helpful and friendly staff of AbleCare will fill your requests promptly, because AbleCare Home Health values your support. AbleCare relies on its good reputation in the medical community for new referrals. AbleCare does not simply expect your support. AbleCare Home Health works constantly to earn your support.

HCPC Codes
G0180 = Initial Certification of Medicare Home Health Care
*National Average Payment = $74.28
G0179 = Recertification of Medicare Home Health Care
*National Average Payment = $56.85

These billing codes are not for Outpatient Physical Therapy or DME. They are only for home health.

Not for Medicaid service

Bill under Medicare Part B which requires physicians to bill co-pay

G0181 = Home Health Care Plan Oversight
*National Average Payment = $124.30

G0181 Tips: Oversight codes represent 30 minutes of care plan coordination in one calendar month (e.g. reading labs, communicating with nurses and therapists, research & decision making, etc.). To avoid retraction of payment, the physician should make notes in the patient’s chart about oversight related activities and the time invested. The 30 minutes need not be all at once. It can be the sum of time invested over one calendar month. For best results, bill oversight during the month following the dates of service. The physician billing for oversight must be the same physician signing the plans of care.

One Nurse + One Patient =
Greater Peace of Mind

Home health can send a disorienting number of people into the homes of your patient. At AbleCare, we assign one nurse to each of your patients, and that one nurse makes all the skilled nursing visits. This reduces the likelihood of errors during care transitions, and it enables your patients to form a good relationship with our home health nurse. In your business, you know how important relationships can be.

Are You Leaving Money on the Table?

One Nurse + One Patient = Greater Peace of Mind

One Nurse + One Patient =
Greater Peace of Mind