Medicare requires doctors to have face-to-face contact with their patients and provide services to them six months before the first billing to Medicare.Besides doctors, physician assistants, nurse practitioners or a nurse clinical specialist may also submit a claim for reimbursement for their services provided that they have an agreement with the doctor who certified the patient. Medicare will only pay one physician per month per patient.
Doctors eligible to bill for Care Plan Oversight are those who certified their patients for home health services and developed treatment plans for them. In the case of hospice, doctors or nurse practitioners who are considered the “attending physician” for the patient may bill for the service. Medicare will not reimburse doctors who have financial relationships with home health agencies or are employees or medical directors of hospice facilities.
Before billing Medicare, doctors must have spent 30 minutes or more each month overseeing their patient’s care. Doctors are also required to document their activities in the patients’ files. According to Medicare, these activities include making medical decisions, phoning other medical professionals involved with the patient to discuss the patient’s care, and reviewing test results, charts, or other treatment plans that were not included when the doctor first saw the patient.
What Medicare will not count toward a doctor’s monthly service are such activities as a calling the patient’s family, processing claims, or simply calling in a prescription for the patient.
It is important for doctors and their staff to throughly review Medicare’s billing requirements to avoid being denied payment for Care Plan Oversight services.