Skip to main content

I'm doing everything right, so why are my homecare reimbursements a problem?

Let's say you are a physician in a rural area and you have a sizable percentage of patients that are seen by homecare agencies

Those patients require additional communication with homecare agencies, and added overhead that comes with managing remote homecare. 

And with a 1/3 of your patients requiring homecare, you and your staff already made changes to your workflow to adapt and adjust for managing and overseeing agency nurses. 

Here are the Top 3 reasons why after doing all the work, reimbursements for your work might still be lagging, often significantly. 

1. Not taking advantage of all the available billing codes

There are 3 main billing codes that you can use as a framework for your reimbursements. 

  1. G0180 - Physician certification for a home health patient
  2. G0179 - Physician recertification for a home health patient
  3. G0181 - Physician supervision of a patient receiving medicare-covered services provided by a participating home health agency 
The first two -- the certification and recertification are easiest because they just require a single document to be signed, and they can simply be billed for. 

Its the third one -- Physician supervision, also referred to as Care Plan Oversight, or CPO -- that is the more complex one and the one billing code that provides the largest reimbursement and makes it possible to bill under that code every 30 days.

CPO requires tracking all the work between the physician and the home health agency, and using that work as basis for billing for CPO, which requires 30 minutes per patient per month to have been done towards patient care.  That is why the best way to do this is with software, rather than manually with papers. Which brings us to the next point...

2. Chasing around for papers and documents 

Billing for any of the home health billing codes mentioned above requires documentation as proof that work was done. You usually dont have to submit this information with your billing, but you have to have it available for auditing purposes.

This requires keeping track of all your certification and recertification documents (easier) and also keeping track of all documentation that shows the 30 minutes of work done for a patent in a given month (slightly harder). Which brings us to the third and final point...

3. Not formalizing all the work you are already doing

Not keeping track of all the billable home health work an oversight you are already doing is the single biggest obstacle towards fully getting reimbursed for your work. You and your agencies are already in touch and doing work together, but is there a proper work and document trail that shows everything that was done? Does the agency send appropriate paperwork to reflect all their work, and do you have all the paperwork that reflects your oversight and instructions?

That is exactly what we at Doctor Alliance focus on and can help you get it all figured out with your free account.