Care Plan Oversight (CPO):
Family physicians and other primary care and specialty physicians are frequently required to manage and coordinate complex medical cases to ensure quality and efficient use of health care resources, particularly in the inpatient setting.
In a similar way, Medicare has recognized this concept as it relates to home health care patients by paying physicians for their involvement in the initial certification, recurrent recertification, and care plan oversight functions.
CPO Qualification Requirements:
Medicare covers the services.
The services are provided by a Medicare licensed home health agency.
One physician per patient may bill CPO.
No less than one qualified face-to-face visit within previous six months.
Certification (485) G0180 – Initial home health certification, also known as reviewing and signing the initial plan of care for the initial 60-day certification period.
Re-Certification (485) G0179 – Recertification of the plan of care ï¿½ if the patient’s care continues for an additional 60 days, the physician must review and sign a recertification plan of care for the subsequent 60-day certification period.Care Plan Oversight (485) G0181 – Home health CPO is indicated for the supervision of a patient under the care of a Medicare-certified home health agency. (Patient is not present). Oversight is indicated for the patient whose care is complex and involves multiple disciplines, thereby requiring regular physician contact
Care Plan Oversight (G0181) activities that are BILLABLE 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 (G0181) billing criteria:
Patient must be receiving Medicare covered home health services.
Physician must demonstrate that 30 minutes or more of supervision to the patient’s care has occurred (see sample tracking tool below).
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.
Bill must include the Medicare provider number of the patient’s home health agency
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.
Care Plan Oversight activities cannot relate to surgery during the immediate post-op period.