Re: billing questions

[Guest guest]

Coumarin monitoring depends on what exactly you are doing. If you review outside labs and adjust meds that way, then you would use the code for that. But, if you do monitoring in-house, the. You bill an office visit (we bill a 99211) plus a fingerstick (not reimbursed) plus the QW lab CPT. Sorry, I'm not in the office to look atthe codes. Can't help with your other questions. I would NOT send chart notes to the lab for bill payment. Often we will get a request for an updated ICD-9 code, but never copies of the chart.

Can someone tell me how to do Care Plan Oversight billing for all these Visiting Nurse orders to be signed and phone conversations? And does this apply to only my Medicare patients of all insurances?

How do I bill for Coumadin monitoring?

How do I answer these labs requests for copies of notes to be paid for lab work drawn?

I just found out after 3 years that I'm supposed to be billing 3 injections for things like MMR shots! at least if I'm reading this right http://practice.aap.org/content.aspx?aid=2980

Hope all are well. Thanks in advance!

[Guest guest]

OK I am taking on the lastthat is for 18 and under , started this year 1.1.11that for mmr for example is90460 1 unit90461 2 unitsand 90707 for the MMR vaccineall tied to diagnosis code V06.4if doing multiple some insurerer will take all the 90460's bunched but united wants each code written next to each vaccineor will reject DRIVE YOU NUTS!LynnTo: practiceimprovement1 From: myriaemeny@...Date: Thu, 3 Nov 2011 07:22:11 -0700Subject: billing questions

Can someone tell me how to do Care Plan Oversight billing for all these Visiting Nurse orders to be signed and phone conversations? And does this apply to only my Medicare patients of all insurances?

How do I bill for Coumadin monitoring?

How do I answer these labs requests for copies of notes to be paid for lab work drawn?

I just found out after 3 years that I'm supposed to be billing 3 injections for things like MMR shots! at least if I'm reading this right http://practice.aap.org/content.aspx?aid=2980

Hope all are well. Thanks in advance!

[Guest guest]

Ok I wll do CPO:My biller once set me this:sometimes private insurances pay  Mostly I do mcr so not sure;Care plan oversight is indicated for the supervision of a patient under the care of a Medicare certified home health agency. The

patient does not need to be present. Oversight is indicated for the patient, whose care is complex and involves multiple disciplines, thereby requiring regular physician contact. In a similar way, Medicare has recognized this concept as it relates to home health care patients by paying physicians for their involvement in the initial certification,

recurrent recertification, and care plan oversight functions. Care

plan oversight can be billed by the physician performing the service for patients receiving home health care under the Medicare benefit. Its HCPCS code is G0181 CPO it was formerly CPT code 99375. Reimbursement rates vary by geographic area and are approximately $115.00-$130.00. Medicare allows separate payment for care plan oversight services under the following conditions:

The beneficiary must require complex or multi-disciplinary care modalities requiring ongoing physician involvement in the patient's plan

of care; The beneficiary must be receiving Medicare covered home health or hospice services during the period in which the care plan oversight services are furnished The physician who bills CPO must be the same physician who signed the home health or hospice plan of care; The physician must furnish at least 30 minutes of care plan oversight within the calendar month for which payment is claimed and no other physician has been paid for care plan oversight within that calendar month; The physician must have provided a covered physician service that required a face-to-face encounter (codes 99201-99263, 99281-99357) with the beneficiary within the 6 months immediately preceding the provision of the first care plan oversight service (a face-to-face encounter does not include EKG, lab services or surgery); The care plan oversight billed must not be routine post-operative care provided in the global surgical period of a surgical

procedure billed by the physician; The care plan oversight services must be personally furnished by the physician who bills them; Services provided " incident to " a physician's service do not qualify as CPO and do not count toward the 30-minute requirement;

The physician may not bill CPO during the same calendar month in

which he/she bills the Medicare monthly capitation payment (90918-90925) (ESRD benefit) for the same beneficiary; Note:

Procedure codes 90918-90925 have changed to an " I " or invalid status effective January 1, 2004 and are being replaced with procedure codes G0308-G0327. The physician billing for Care Plan Oversight must document in the patient's record which services were furnished and the date and length of time associated with those services. and

 

 

Jurisdiction 1 Part B

Care Plan Oversight Services

 

Care Plan Oversight

(CPO) is physician supervision of patients under either the home health or

hospice benefit where the patient requires complex or multi-disciplinary care

requiring ongoing physician involvement. Medicare does not pay for care plan

oversight services for nursing facility or skilled nursing facility patients.

Separate payment is allowed for the services involved in physician

certification/re-certification and development of a plan of care for Medicare

covered home health services.

HCPCS code G0179 is to be used for re-certification after a patient has

received services for at least 60 days (or one certification period). HCPCS

code G0179 will be reported only once every 60 days, except in the rare

situation when the patient starts a new episode before 60 days elapses and

requires a new plan of care to start a new episode.

HCPCS code G0180 is to be used when the patient has not received Medicare

covered home health services for at least 60 days. The initial certification

(HCPCS code G0180) cannot be filed on the same date of service as the

supervision service HCPCS codes (G0181 or G0182).

HCPCS Codes

G0179: MD re-certification HHA PT

G0180: MD certification HHA patient

G0181: Home health care supervision

G0182: Hospice care supervision

How to submit a claim

Physicians must submit the six-character Medicare

provider number for the HHA or hospice rendering covered Medicare services

during the period the care planning was furnished. The physician is

responsible for obtaining the Medicare provider number for the HHA or

hospice that is responsible for the plan of care he/she has signed for the

beneficiary and that is providing Medicare-covered services to the

beneficiary.   For paper claims, the six-character Medicare

provider number of the HHA or hospice must be entered in Item 23 of the

CMS-1500 For claims submitted electronically, the six-character

number must be in loop 2310D/REF/LU/02 (NM1/01=FA) or 2420C/REF/LU/02

(MN1/01=FA) Claims submitted for care plan oversight services with

an invalid or missing HHA or hospice Medicare provider number will be

rejected as unprocessable and must be refiled as a new claim, but not

submitted as a review

Note: There is no place

on the HIPAA standard ASC X12N 837 professional format to specifically include

the HHA or hospice provider number required for a care plan oversight claim.

For this reason, the requirement to include the HHA or hospice provider number

on a care plan oversight claim is temporarily waived until a new version of

this electronic standard format is adopted under HIPAA and includes a place to

provide the HHA and hospice provider numbers for care plan oversight claims.

Claims for care plan oversight services will be denied

when: Review of beneficiary claims history files fails to

identify a covered physician service requiring a face-to-face encounter

by the same physician during the six months preceding the provision of

the first care plan oversight service   Only use CPT codes 99201-99263 and 99281-99357

for face-to-face meeting encounters.  Dates of service entered on the claim form:

HCPCS codes G0181 or G0182 must be the first and last

date during which documented care planning services were actually

provided during the calendar month. They should not be the first and last

calendar date of the month in which the claim is submitted. Medical records for those dates must document:

30 minutes or more were spent by the physician for

countable care planning activities The specific service furnished including the date and

length of time Claims submitted without the first and last date will

be rejected as unprocessable The physician must:

Report care plan oversight services on the claim

 Not submit the claim until after the end of the

month in which the service is performed Report care planning only once per calendar month

Report only one month's services per line item

- Show quoted text -

 

OK I am taking on the lastthat is for 18 and under , started this year 1.1.11that for mmr for example is90460 1 unit90461 2 unitsand 90707 for the MMR vaccineall tied to diagnosis code V06.4

if doing multiple some insurerer will take all the 90460's bunched but united wants each code written next to each vaccineor will reject DRIVE YOU NUTS!LynnTo: practiceimprovement1

From: myriaemeny@...Date: Thu, 3 Nov 2011 07:22:11 -0700Subject: billing questions

 

Can someone tell me how to do Care Plan Oversight billing for all these Visiting Nurse orders to be signed and phone conversations?  And does this apply to only my Medicare patients of all insurances?

 

How do I bill for Coumadin monitoring?

 

How do I answer these labs requests for copies of notes to be paid for lab work drawn?

 

I just found out after 3 years that I'm supposed to be billing 3 injections for things like MMR shots! at least if I'm reading this right http://practice.aap.org/content.aspx?aid=2980 

 

Hope all are well.  Thanks in advance!

 

 

--      MD          ph    fax

[Guest guest]

OH YOU GUYS are the best! Thanks for the laughter and sharing as each of you took one my questions! You are all the best. Thanks.

To: Sent: Thursday, November 3, 2011 12:07 PMSubject: Re: billing questions

Ok I wll do CPO:My biller once set me this:sometimes private insurances pay Mostly I do mcr so not sure;Care plan oversight is indicated for the supervision of a patient under the care of a Medicare certified home health agency. The patient does not need to be present. Oversight is indicated for the patient, whose care is complex and involves multiple disciplines, thereby requiring regular physician contact. In a similar way, Medicare has recognized this concept as it relates to home health care patients by paying physicians for their involvement in the initial certification, recurrent recertification, and care plan oversight functions. Care plan oversight can be billed by the physician performing the service for patients receiving home health care under the Medicare benefit. Its HCPCS code is G0181 CPO it was formerly CPT code 99375. Reimbursement rates vary by geographic area and are approximately

$115.00-$130.00. Medicare allows separate payment for care plan oversight services under the following conditions:

The beneficiary must require complex or multi-disciplinary care modalities requiring ongoing physician involvement in the patient's plan of care;

The beneficiary must be receiving Medicare covered home health or hospice services during the period in which the care plan oversight services are furnished

The physician who bills CPO must be the same physician who signed the home health or hospice plan of care;

The physician must furnish at least 30 minutes of care plan oversight within the calendar month for which payment is claimed and no other physician has been paid for care plan oversight within that calendar month;

The physician must have provided a covered physician service that required a face-to-face encounter (codes 99201-99263, 99281-99357) with the beneficiary within the 6 months immediately preceding the provision of the first care plan oversight service (a face-to-face encounter does not include EKG, lab services or surgery);

The care plan oversight billed must not be routine post-operative care provided in the global surgical period of a surgical procedure billed by the physician;

The care plan oversight services must be personally furnished by the physician who bills them;

Services provided "incident to" a physician's service do not qualify as CPO and do not count toward the 30-minute requirement;

The physician may not bill CPO during the same calendar month in which he/she bills the Medicare monthly capitation payment (90918-90925) (ESRD benefit) for the same beneficiary; Note: Procedure codes 90918-90925 have changed to an "I" or invalid status effective January 1, 2004 and are being replaced with procedure codes G0308-G0327.

The physician billing for Care Plan Oversight must document in the patient's record which services were furnished and the date and length of time associated with those services. and

Jurisdiction 1 Part B

Care Plan Oversight Services

Care Plan Oversight (CPO) is physician supervision of patients under either the home health or hospice benefit where the patient requires complex or multi-disciplinary care requiring ongoing physician involvement. Medicare does not pay for care plan oversight services for nursing facility or skilled nursing facility patients. Separate payment is allowed for the services involved in physician certification/re-certification and development of a plan of care for Medicare covered home health services. HCPCS code G0179 is to be used for re-certification after a patient has received services for at least 60 days (or one certification period). HCPCS code G0179 will be reported only once every 60 days, except in the rare situation when the patient starts a new episode before 60 days elapses and requires a new plan of care to start a new episode.HCPCS code G0180

is to be used when the patient has not received Medicare covered home health services for at least 60 days. The initial certification (HCPCS code G0180) cannot be filed on the same date of service as the supervision service HCPCS codes (G0181 or G0182).HCPCS CodesG0179: MD re-certification HHA PTG0180: MD certification HHA patientG0181: Home health care supervisionG0182: Hospice care supervisionHow to submit a claim

Physicians must submit the six-character Medicare provider number for the HHA or hospice rendering covered Medicare services during the period the care planning was furnished. The physician is responsible for obtaining the Medicare provider number for the HHA or hospice that is responsible for the plan of care he/she has signed for the beneficiary and that is providing Medicare-covered services to the beneficiary.

For paper claims, the six-character Medicare provider number of the HHA or hospice must be entered in Item 23 of the CMS-1500

For claims submitted electronically, the six-character number must be in loop 2310D/REF/LU/02 (NM1/01=FA) or 2420C/REF/LU/02 (MN1/01=FA)

Claims submitted for care plan oversight services with an invalid or missing HHA or hospice Medicare provider number will be rejected as unprocessable and must be refiled as a new claim, but not submitted as a review

Note: There is no place on the HIPAA standard ASC X12N 837 professional format to specifically include the HHA or hospice provider number required for a care plan oversight claim. For this reason, the requirement to include the HHA or hospice provider number on a care plan oversight claim is temporarily waived until a new version of this electronic standard format is adopted under HIPAA and includes a place to provide the HHA and hospice provider numbers for care plan oversight claims.

Claims for care plan oversight services will be denied when:

Review of beneficiary claims history files fails to identify a covered physician service requiring a face-to-face encounter by the same physician during the six months preceding the provision of the first care plan oversight service

Only use CPT codes 99201-99263 and 99281-99357 for face-to-face meeting encounters.

Dates of service entered on the claim form:

HCPCS codes G0181 or G0182 must be the first and last date during which documented care planning services were actually provided during the calendar month. They should not be the first and last calendar date of the month in which the claim is submitted.

Medical records for those dates must document:

30 minutes or more were spent by the physician for countable care planning activities

The specific service furnished including the date and length of time

Claims submitted without the first and last date will be rejected as unprocessable

The physician must:

Report care plan oversight services on the claim

Not submit the claim until after the end of the month in which the service is performed

Report care planning only once per calendar month

Report only one month's services per line item

- Show quoted text -

OK I am taking on the lastthat is for 18 and under , started this year 1.1.11that for mmr for example is90460 1 unit90461 2 unitsand 90707 for the MMR vaccineall tied to diagnosis code V06.4if doing multiple some insurerer will take all the 90460's bunched but united wants each code written next to each vaccineor will reject DRIVE YOU NUTS!Lynn

To: practiceimprovement1 From: myriaemeny@...Date: Thu, 3 Nov 2011 07:22:11 -0700Subject: billing questions

Can someone tell me how to do Care Plan Oversight billing for all these Visiting Nurse orders to be signed and phone conversations? And does this apply to only my Medicare patients of all insurances?

How do I bill for Coumadin monitoring?

How do I answer these labs requests for copies of notes to be paid for lab work drawn?

I just found out after 3 years that I'm supposed to be billing 3 injections for things like MMR shots! at least if I'm reading this right http://practice.aap.org/content.aspx?aid=2980

Hope all are well. Thanks in advance!

-- MD ph fax

[Guest guest]

You're undercharging if you're seeing the patient and billing a

99211.  That's only used if you have a nurse seeing the patient.  If

a physician or midlevel sees the patient the minimum charge is

99212.

We decline to manage coumadin over the phone.

 

Coumarin monitoring depends on what exactly you are

doing. If you review outside labs and adjust meds that

way, then you would use the code for that. But, if you do

monitoring in-house, the. You bill an office visit (we

bill a 99211) plus a fingerstick (not reimbursed) plus the

QW lab CPT. Sorry, I'm not in the office to look atthe

codes. Can't help with your other questions. I would NOT

send chart notes to the lab for bill payment. Often we

will get a request for an updated ICD-9 code, but never

copies of the chart. 

On Nov 3, 2011, at 7:22 AM, Myria

wrote:

 

Can someone tell me how to do Care Plan

Oversight billing for all these Visiting Nurse

orders to be signed and phone conversations?  And

does this apply to only my Medicare patients of

all insurances?

 

How do I bill for Coumadin monitoring?

 

How do I answer these labs requests for copies

of notes to be paid for lab work drawn?

 

I just found out after 3 years that I'm

supposed to be billing 3 injections for things

like MMR shots! at least if I'm reading this right

http://practice.aap.org/content.aspx?aid=2980 

 

Hope all are well.  Thanks in advance!

 

 

[Guest guest]

Crazy.Sharon 

 

OK I am taking on the lastthat is for 18 and under , started this year 1.1.11that for mmr for example is90460 1 unit90461 2 unitsand 90707 for the MMR vaccineall tied to diagnosis code V06.4

if doing multiple some insurerer will take all the 90460's bunched but united wants each code written next to each vaccineor will reject DRIVE YOU NUTS!LynnTo: practiceimprovement1

From: myriaemeny@...Date: Thu, 3 Nov 2011 07:22:11 -0700Subject: billing questions

 

Can someone tell me how to do Care Plan Oversight billing for all these Visiting Nurse orders to be signed and phone conversations?  And does this apply to only my Medicare patients of all insurances?

 

How do I bill for Coumadin monitoring?

 

How do I answer these labs requests for copies of notes to be paid for lab work drawn?

 

I just found out after 3 years that I'm supposed to be billing 3 injections for things like MMR shots! at least if I'm reading this right http://practice.aap.org/content.aspx?aid=2980 

 

Hope all are well.  Thanks in advance!

 

 

[Guest guest]

We have a nurse doing the visits. If steve (MD) sees them, it's at least a 99212.

You're undercharging if you're seeing the patient and billing a

99211. That's only used if you have a nurse seeing the patient. If

a physician or midlevel sees the patient the minimum charge is

99212.

We decline to manage coumadin over the phone.

Coumarin monitoring depends on what exactly you are

doing. If you review outside labs and adjust meds that

way, then you would use the code for that. But, if you do

monitoring in-house, the. You bill an office visit (we

bill a 99211) plus a fingerstick (not reimbursed) plus the

QW lab CPT. Sorry, I'm not in the office to look atthe

codes. Can't help with your other questions. I would NOT

send chart notes to the lab for bill payment. Often we

will get a request for an updated ICD-9 code, but never

copies of the chart.

On Nov 3, 2011, at 7:22 AM, Myria

wrote:

Can someone tell me how to do Care Plan

Oversight billing for all these Visiting Nurse

orders to be signed and phone conversations? And

does this apply to only my Medicare patients of

all insurances?

How do I bill for Coumadin monitoring?

How do I answer these labs requests for copies

of notes to be paid for lab work drawn?

I just found out after 3 years that I'm

supposed to be billing 3 injections for things

like MMR shots! at least if I'm reading this right

http://practice.aap.org/content.aspx?aid=2980

Hope all are well. Thanks in advance!