All patients of CUHS must have a physician directing the care for an acute condition or exacerbation of an existing condition
How to make a referral to CUHS:
- Prior to making the service request to CUHS, 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 CUHS at (626) 332-3767anytime 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 CUHS at (626) 332-3767.
- Once you have successfully made your first referral to CUHS, you can fax subsequent referrals to CUHS at (626) 332-9979, 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 (626) 332-3767.
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.
Physician Supervision Of Home Health Services
Care Unlimited Health Services wants to work with you to save you time, reduce your stress, and give your patients the highest quality of care. Pay for performance is on the horizon and we are on your side. We want to provide you with information you need to bill Medicare for your part in the home health process.
When you make a referral to Care Unlimited Health Services, we will mail you a plan of care (form 485) which must be reviewed and signed by you. This validates the medical necessity of the services ordered. The original must be returned to us. We will mail you the patient’s 485 update every 60 days as required by Medicare. At this time, you can re-certify the patient for continued home health services if you choose. At the end of every month, we will send you a list of your patients who have been discharged from our services. This will allow your billing person to know how and when to bill for reimbursements.
2008 Medicare CPO Reimbursement Rates – Code Description Rate
G0180 MD Certification for HH patient $66.72
G0179 MD Re-Certification for HH patient $51.73
G0181 Home Health Care Supervision $114.38
You can bill Medicare for home health certification, re-certification, and supervision. Each service has a separate billing code. Home health care supervision requires 30 documented minutes of physician care plan oversight per month. Download the form. Please contact me at (626) 332-3767 or firstname.lastname@example.org for additional help or information.
Carol Wedderburn – Administrator
Care Unlimited Health Services