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For Physicians and Other Referral Sources
Referral Instructions
Care Plan Oversight for Medicare Home Health Patients
Certification/Recertification of Home Health Plans
Physician Oversight Billing form
All patients of VNS must have a physician directing the care for an acute condition or exacerbation of an existing condition
How to make a referral to VNS:
- Prior to making the service request to VNS, please have the following
information available:
- MD's name that will be signing orders for service
- Patient specific information
• Patient identifying information that will include at least, name, address, phone number, insurance that will be billed for the service, etc.
• Patient's functional limitations that restrict their ability to travel to MD's or clinics to access care - Detailed instructions for the services needed
• Disciplines needed (skilled nursing, physical therapy, speech language pathology, occupational therapy, home health aide in conjunction with professional service)
• Specific procedures for the skilled service
• All pertinent diagnoses including the primary problem requiring the skilled service - Start of care date
- Other suppliers that will be providing supplies or services to the patient
When
the above information has been obtained, call VNS at (607) 273-0466
anytime of day with the referral. Our preferred time for accepting referral
requests is Monday through Friday between 8:30AM and 4:30PM.
• Sometimes it is easier to communicate prescribed medications or procedures by faxing the documentation to VNS at (607) 277-1494.- Once you have successfully made your first referral to VNS, you can fax subsequent referrals to VNS at (607) 277-1494, and we will telephone you with any additional questions about the referral.
- The first visit will occur within 24 hours of receiving the referral or as otherwise requested by the patient or physician.
- If the referral source is not a physician, the admitting clinician will call the physician's office for verbal orders in order to commence care.
If you have questions, please feel free to phone us at (607) 273-0466.
Since 1995, physicians that oversee the complex care needs of Medicare home health patients can be reimbursed for these services. In addition, since 2001, physicians can also bill for the services associated with certifying and recertifying home health services for their Medicare patients.
Physician Care Plan Oversight is defined as physician supervision of a patient (patient not present) under the care of a Medicare Certified Home Health Agency (HCPCS CODE G0181) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) with other health care professionals involved in patient'’ care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 30 minutes or more.
To receive payment the physician:
- Must provide service to Medicare beneficiaries receiving covered home health/hospice services;
- Must have had a face to face encounter with the patient in the six months prior to the first billing for care plan oversight services; and
- May not have a relationship with the home health agency that is prohibited by the Stark II (Physician Self-Referral) regulation.
Please be aware that surgeons may bill for post-surgical care plan oversight if documentation shows the care is unrelated to the surgery.
Medicare requires the physician to document the services that were furnished, the date, and the length of time associated with those services. Visiting Nurse Service has created an editable and printable Physician Oversight Billing form to assist you in keeping track of this information. This form is for your personal billing use and does not need to be returned to Visiting Nurse Service. We send this form to the primary physician for each of our Medicare patients along with the Home Health Plans of Care for review and signature.
Certification And Re-Certification Services:
Physician Certification of Home Health Plan of Care (HCPCS Code G0180) is defined as physician services for initial certification of Medicare-covered home health services, billable once for a patient’s home health certification period. This code will be used when the patient has not received Medicare-covered home health services for at least 60 days.
Physician Re-certification of Home Health Plan of Care (HCPCS Code G0179) is defined as physician services for recertification of Medicare covered home health services, billable once for a patient’s home health certification period. This code would be used after a patient has received services for at least 60 days (or one certification period) when the physician signs the certification after the initial certification period.
We recommend that physicians retain a copy of the signed HCFA-485 (home health plan of care), signed interim or telephone orders, or any other documentation that would support provision of these services.
Billing Notes: Physicians bill for Care Plan Oversight or certification/recertification using Form HCFA 1500. The claim for these services must contain the home health agency’s 6-digit Medicare provider number (Visiting Nurse Service’s Medicare Provider Number is 33-7212). . The dates of service should be the date the physician provided the service, not the Medicare beneficiary’s dates of services. Specifically, the dates of service on the HCFA 1500 should be:
- Care Plan Oversight: FROM the date of the first CPO service provided in the calendar month TO the date of the last CPO service provided in the calendar month.
- Certification/Recertification: The date the physician signs the plan of care.
Medicare requires the physician to document the services that were furnished, the date, and the length of time associated with those services. Visiting Nurse Service has created an editable and printable Physician Oversight Billing form to assist you in keeping track of this information. This form is for your personal billing use and does not need to be returned to Visiting Nurse Service. We send this form to the primary physician for each of our Medicare patients along with the Home Health Plans of Care for review and signature.