I read Kent Moore's post “Facing the new face-to-face requirement for Medicare home health services” (March 11, 2011) on FPM's “Getting Paid” blog, and I have a few questions: If a patient is in the hospital and the hospitalist certifies the plan of care and requests home health services, does the hospitalist receive the payment for the certification? As the patient's primary care physician, do I then complete the recertification in three months? Who is responsible for the orders that home health sends me in the 90-day interim? I'm unsure of who gets paid for what and who is responsible for what for these services.
If the hospitalist certifies the Medicare-covered home health services under a home health plan of care, he or she would submit the claim for payment of code G0180. If you subsequently perform the recertification, then you would submit the claim for payment of code G0179; this code may be used after a patient has received home health services for at least 60 days. You do not have to see the patient before recertifying his or her home health care; according to the Centers for Medicare & Medicaid Services, the face-to-face visit requirement applies only to certifications, not recertifications.
Responsibility for managing orders and interactions with the home health agency (i.e., the care plan oversight) in between the certification and recertification belongs to the person who retains responsibility for the patient at the time of certification. If the hospitalist certifies the plan of care and hands off the patient to you as the community physician, then you are responsible for the subsequent care plan oversight (assuming that you accept the hand off). As a reminder, care plan oversight of a patient receiving Medicare-covered home health services is billable using code G0181, provided the care plan oversight was 30 minutes or more in a calendar month.