Home Health & Hospice Week

Assist physicians in learning the cert/recert billing ropes with these 5 steps.

Your physician referral sources could be overlooking a healthy source of income if they're neglecting to bill for their home health certifications and recertifications. You can gain their esteem - and perhaps their business - by showing them how to do it.

Unlike billing for care plan oversight (CPO), which requires documentation of 30 minutes of services per month, billing for certs and recerts is fairly simple and straightforward. Docs can bill HCPCS codes G0180 (cert) and G0179 (recert) when they certify or recertify the patient's home health plan of care every 60 days.

But a lot of docs have no idea they can bill for this service they already are furnishing. "Many physicians seem to be unaware that it exists," observes Heath-er Vasek with the Texas Association for Home Care.

Heed this expert advice on how to educate your physician referral sources on cert/recert billing:

1. Prove it. "Physicians certainly have to prove that they actually certified/recertified patients," advises Burtonsville, MD-based health care attorney Elizabeth Hogue. "They should do that by keeping a copy of each [cert] in patients' records."

"Many carriers will accept a copy of the signed orders as verification for care cert/recert," points out Dr. Peter Boling, professor of medicine at Virginia Com-monwealth University in Richmond.

2. Document it. To be on the safe side, advising physicians to add documentation in the patient's chart is a good idea. "Some providers ... dictate/write a brief note outlining the activities performed related to (re)certification," notes Dr. Edward Ratner, medical director for Heartland Home Health Care and Hospice in Minneapolis.

"I have advised physicians that they should also write a one-line note in the chart, which is my practice," Boling says.

3. Don't double-count. If the referral source is claiming CPO too, remind him that he can't count activities toward both cert/recert and CPO. "The work and time spent developing the plan of care for the certification must be separate and apart from the time counted toward care plan oversight," Medicare Part B carrier TrailBlazer Health Enterprises says in its local coverage determination on cert/recert. That includes reviewing data such as OASIS.

4. Make it easy on them. To help remind physicians to bill for and document their home care services, you can provide them with a cert/recert worksheet. That's what Emeryville, CA-based Sutter VNA & Hospice does.

Sutter's worksheet is geared mainly toward helping docs document their CPO activities. But it also prompts physicians to record their cert or recert and sign and date the documentation sheet. And the form gives physician offices the VNA's provider numbers and the service HCPCS codes required for billing.

View the form online through links at www.suttervnaandhospice.org/doctors/doctors_cpo.html.

5. Share billing information. If your physicians aren't sure how to bill, refer them to the Medicare Claims Processing Manual, Chapter 12, p. 164 at www.cms.hhs.gov/manuals/104_claims/clm104c12.pdf. The manual explains the codes and how often to bill them.

And if the Part B carrier in your state has a local coverage determination for the codes, be sure to share that as well, Vasek advises.

For example, TrailBlazer's LCD requires physicians to show their participation in the development of the plan of care. The LCD is at www.trailblazerhealth.com/lmrp.asp?ID=1861&lmrptype=tx.