Many physiatrists are unaware of their ability to bill for Certifications of Home Health Service, and have lost many thousands of dollars over the past ten years.


Background

Physicians have always been able to bill for Care Plan Oversight services.  However,the physician must meet and document that he/she has spent 30 minutes within the month providing these services.  Most physicians do not meet the 30-minute time requirement – and many feel that the effort to document the 30 minutes is just too difficult, and therefore do not bill.  However, since October 1, 2000, physicians have been able to bill for Home Health Certifications, defined as “Physician certification for Medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care that meets patient’s needs, per certification period (60 days).”

How it works

Physiatrists often receive Medicare Form CMS-485 which is entitled “Home Health Certificationa nd Plna of Care” for patients discharged from their inpatient service.  Physiatrists review these plans of care, sign them, and return them to their Home Health Agency.  Believe it or not, many physiatrists are not aware that they can bill for these services.  But wait, there’s more!  After 60 days, the patients may be Re-certified for another 60 days of home health services, and another Certification form will be signed by the physician.  This second 60-day Certification is ALSO billable, although with a different CPT code.

Reimbursement

Medicare reimbursement is over $50 for the initial Home Health Certification, and over $40 for each Re-certification.  If you have not been billing for these services for the past ten years, and if you have had an average of two Certifications per month, you have lost income of well over $10,000.  If so, don’t look back, but bill going forward.

Bruno Stillo, CPA is the owner of Physiatry Billing Specialists, 800-835-4482, [email protected]

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