By Jimmie Hebert, CPC, CMCA-EM, CMC, CMOM, CMIS
Do you have patients that have complex medical needs that require home health or hospice care? If you are the clinician that ordered the service and are coordinating the care, and signed the plan of care, you may be reimbursed for your time. The clinician billing the services must personally perform the services. Care coordination services delegated to or performed by others, including residents, do not count towards care coordination reimbursement. Only one provider, per patient, may bill for these services one time per month with at least 30 minutes.
The record must substantiate at least 30 minutes of personal non-face-to-face physician or APP time per calendar month. Records must show detailed, time stamped activities, and confirm a prior face-to-face visit within the past 6 months.
These services or for patients requiring complex and multidisciplinary care modalities involving regular development and/or revision of care plans by that individual, review or subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) for purposes of assessment or care decisions with healthcare professionals, family members, surrogate decision makers, legal guardians and/or key caregivers involved in the patient’s care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month.
Clinician-directed care coordination services must be documented in the client’s medical record. Documentation must support the services being billed and must include a record of the medical home clinician’s time spent performing specific care coordination activities, including start and stop times. The documentation must also include a formal care plan and an emergency services plan. The supporting documentation maintained in the client’s medical records must be dated and include the following components and requirements: problem list, interventions, short-term and long-term goals, and responsible parties. Documentation for care coordination provided during post-surgical care must clearly indicate the care coordination is unrelated to the surgery.
Medicaid and Medicare along with some other payors will reimburse one CPO code per calendar month per patient. Prior authorization is required by many of the payors.