Changed Requirements for Home Health Care Certification for 2011

December 20th, 2010

Beginning January 1, 2011 a physician who certifies Medicare home health services must see the patient within 90 days before or 30 days after the home health certification.  Although a NPP still cannot certify a patient for home health services, the required exam may be provided by a NPP who works incidental to or in collaboration with the physician.

The physician will be required to document when he had a face-to-face encounter with the patient and to document how the patient’s clinical condition supports the need for skilled home health services as part of the certification form.  Attachments to the form are also acceptable.  Thus a physician may wish to include the required elements in his note for the date of service to support the certification.  The note could then be attached to the certification form.

The new requirements does have some positives for physicians:

  • A NPP may provide the face-to-face encounter,
  • A hospitalist may certify the need for home health care based on their face to face contact with the patient in the hospital,  establish and sign the plan of care the transfer care to another physician, and 
  • In rural areas, the law allows the face-to-face encounter to occur via telehealth, in an approved originating site.   

To learn more visit the Medicare Learning Network website at:

Home health care certifications and recertifications is an area frequently missed by physicians.  Care 

In order to bill for managing patients in home health care, you simply use code G0180 for initial certification, and G0179 for each follow up.  Certification and recertification pays approximately $30 to $40.

If you document phone calls and faxes, and keep copies of the certifications in the chart, you can bill for these services.  The payment for managing these patients is approximately $70 per month.

Of course, always document.

Care Plan Oversight activities that are BILLABLE include as part of Care Plan Oversight include:

  • Communication with interdisciplinary team and pharmacist, including phone calls or other verbal communication.
  • Review of patient status reports.
  • Modification of plan of care, including the review and signing of modification orders.
  • Review of lab results, reports, and records.

Care Plan Oversight billing criteria:

  • Patient must be receiving Medicare covered home health services.
  • Physician must document that 30 minutes or more of supervision to the patient’s care has occurred
  • Physician must have seen the patient at least once during the six-month period prior to Care Plan Oversight billing.
  • Physician is the only physician billing for Care Plan Oversight for the particular patient.
  • The physician billing for Care Plan Oversight must be the physician who signed the home health plan of care or the physician who was received the "hand off" for monitoring the care..

Other considerations:

  • Always retain the home care Plan of Treatment in the patient’s medical record.
  • Minimum billable time is 30 cumulative minutes dedicated to the patient’s care over a 30-day period. Document the time in the patient's medical record.
  • Care Plan Oversight activities cannot relate to post-op periods in global surgery packages UNLESS patient is being monitored for an unrelated condition.

To help you capturing Home Health Care Plan Charges, KLA has developed a tracking form for your use.


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