Physician Bulletins: Below, you will find a sample of the community-based healthcare utilization bulletins that we routinely mail to referring doctors and other healthcare professionals.
Did you know that doctors have seven different codes they can bill to receive additional reimbursement for the work they do with Ava-tar’s Home Health & Hospice? At the very least, doctors should be billing for certification and recertification every
time they sign a plan of care (form CMS 485). The certification code pays roughly the equivalent of a level-III office visit, and the recertification code pays a little more than a level-II office visit. The documentation requirements for these
codes are nothing more than saving the paper-work you are reviewing. Avatar Home Health Agency very much values the oversight provided by our referring physicians. We prepared this bulletin to help doctors make sure they are receiving full reimbursement
for the valuable services they provide.
of Medicare Home Health Care
*Payment comparable to a Medicare level-III visit
of Medicare Home Health Care
*Payment greater than Medicare level-II visit
• These billing codes are not for Outpatient Physical Therapy or DME. They are only for home health.
• Bill under Medicare Part B which requires physicians to bill co-pay
*Payment greater than double a level-II visit Covers activities such as review of charts, reports, treatment plans, lab results, and study results. Covers physician’s telephone calls with home health personnel. Does not cover physician conversations with own employees or team conferences with fellow employees. Does not cover review of labs other-wise compensated. Many guidelines for billing G0181 exist.
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. Services covered under G0180 and G0179 cannot be counted toward G0181.
When these codes were first launched, the These codes pay doctors for one office visit occurring within seven or fourteen days of a hospital discharge with a large bonus for medication reconciliation and all the work of coordinating other outpatient care such as home health, hospice, pharmacists, other doctors, etc. Reimbursement can be well over $200. This code is meant to incentivize offices to call patients right after a hospital discharge and get them in for an office visit. It essentially describes a program for transitional care management that is largely what most doctors do anyway.
Medicare’s approval of CPT 99490 has the potential to CPT 99490 covers doctor and clinical staff time for non-face-to-face care coordination services with other healthcare providers. CPT 99490 covers at least 20 minutes of clinical staff time per calendar month coordinating care with other providers for Medicare beneficiaries with two or more chronic conditions. Physicians, physician assistants, nurse practitioners, certified nurse midwives, and certified nurse specialists may bill 99490 which does cover the time of other clinical staff operating under the prescriber’s direction. Medicare will pay roughly $126 per hour.