Archive for the ‘Physician Orders’ Category

Physicians and Care Plan Oversight (CPO) and Certification/Recertification

Tuesday, May 15th, 2012

Care Plan Oversight is physician supervision of patients under either the home health or hospice CMS benefit. CMS does not provide this reimbursement for these services if a patient resides in a nursing facility or skilled nursing facility.

Physicians should be made aware of this reimbursable service. They must review the Plan of Care and be made aware of the reimbursement for the process.

Understand the Difference between CPO and Certification/Recertification

G0180 – Certification of a home health patient.

G0179 – Recertification of a home health patient

G0181 – Home Health Care Plan Oversight

G0182 – Hospice Care Plan Oversight

Care Plan Oversight reimbursement allows physicians to bill CMS for the time physicians oversee the home health plan of care. The physician may bill for 30 minutes of time each month as long as they log the care delivered and it is allowable care for CPO. Remember: the face to face encounter must be included as part of the certification form itself, or as a signed addendum to it, and must include the certifying physician’s distillation of the patient’s clinical condition and needs for home care. It must also attest to homebound status and medical necessity.

Certification billing requirements include:

  • The physician signing the Plan of Care is the physician who may bill for CPO
  • Date of Service: Date the physician signs the POC
  • List home health agency provider number
  • List physician NPI number
  • List the care provided that meets the required services for payment

 

Recertification billing requirements:

  • Must be billed by the physician who recertified the patient
  • Used after a patient has received 60 days of covered skilled intermittent Medicare services
  • Date of service: Date the physician signed the POC
  • List agency provider number
  • List physician NPI number

 

What is CPO?

 

CPO is physician supervision and oversight of patients under either home health G0181 or the CMS hospice benefit G0182. The home health services may include:

    Developing an individualized plan of care

    Telephone calls with other health care physicians involved with the care

    Revising a plan of care

    Activities involving coordinating of care

    Documentation of planning

    Medical Decision Making

    Review of treatment plans, and analysis of labs, tests, and data analytics

    Team conferences

The beneficiary must require complex and/or interdisciplinary care. The physician may not have a significant financial or contractual interest in the home health agency. The physician may not be the medical director or employee of the hospice, and does not provide service under arrangement with the hospice.

Documentation must be completed by the physician and not the home health agency.

Non – Countable Services

 

  • Initial interpretation of a lab during a face to face encounter
  • Informal calls with office personnel
  • Telephone calls to patients, family, even if medication adjustment occurs
  • Travel time
  • Time preparing claims

 

Billing/Filing the Claim

Medical records for the dates must document the 30 or more allowable minutes for care planning activities for each patient. Dates of services must be the first and last date during which documented planning services were provided. No other services,  but from the CPO may be on the claim.

Agencies should spend the time to educate physicians to this reimbursement possibility. Have a simple fact sheet available with the steps to complete the process identified but do not complete the form for the physician. Offer a sample log to physicians so they may see what can be billed. Provide  the link to the CMS site so the physicians  may read the complete process outlined by CMS.

http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads//R999CP.pdf

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P.O.L.S.T. Physician Orders for Life-Sustaining Treatment

Monday, August 8th, 2011

Select Data serves home health and hospice agencies throughout the country and the Virgin Islands. One agency, not from a POLST state recently asked that we write an article on POLST as they had seen the abbreviation on the Select Data SmartScribe forms. Their state is considering a move toward the Physician Orders for Life-Sustaining Treatment Paradigm program.

The POLST program is designed to improve the quality of care received by individuals at the end of life. It is designed to effectively communicate patient wishes through physician orders on a highly colored form (usually PINK) so as not to be missed by health care professionals.

What is the Difference Between POLST and Advance Directives?

POLST is a document that clearly states a patient’s end of life wishes and includes physician orders and patient signature. Advance Directives generally contain information about a person’s desire to be mechanically ventilated, artificially fed, and comfort measures. Advance Directives will not actively protect against unwanted emergency care, resuscitation specifics, or a transfer to an acute care setting. POLST includes CPR wishes, artificial nutrition choices, and specific statements identifying if a transfer to a hospital is desired. POLST has physician orders to back up the patient’s wishes.

History of the POLST Paradigm Initiative

Despite advance directives, medical ethics leaders recognized that patient wishes for life-sustaining treatments were not consistently being honored. In 1991, in Oregon, the POLST Paradigm Initiative was begun.  The Medical Treatment Coversheet, designed to transport portable medical orders based upon the patient’s wishes emerged from the Initiative lead by The Center for Ethics in Health Care at Oregon Health and Science University. With stakeholders from several health care organizations, the Center coordinated the training of health care professionals regarding use of the form.

In 1995, the name of the Initiative was changed to Physician Orders for Life-Sustaining Treatment and the form was released for full use in Oregon. As the program satisfaction grew, other states sought legislation to initiate the program. West Virginia and New York were forerunners in program adoption and they lead the way in learning to integrate the new program within state specific laws.

Presently,(per www.obsu.edu/polst ), the Medical Treatment Coversheet is used by over 95% of nursing homes in Oregon and used by all hospices. It is considered “the accepted medical standard of care.” Together, with Oregon members, program leaders of New York, Pennsylvania, West Virginia, and Wisconsin joined together forming the original National POLST Paradigm Initiative Task Force. That Task Force has been instrumental in driving POLST Program development in California, Washington, Idaho, Colorado, Tennessee, and Virginia with several other states, such as Texas, Florida, Georgia, Indiana, Alaska, and Ohio actively developing programs.

The National POLST Paradigm Task Force (NPPTF): Program Requirements

The Task Force developed the description of the program with specific program requirements. The Program Structure requires an “effective statewide or regional coalition” working on a strategy to establish statewide implementation.

The Program requires a set of medical orders on the Medical Treatment Coversheet. There must be ongoing training of health care professionals at all levels, that includes an understanding of the POLST Program, its goals, use of the Form, as well as understanding “how to conduct a POLST conversation.” (www.obsu.edu/polst)

The Medical Treatment Coversheet includes physician signature. The patient signature is encouraged to be on the completed form as well which includes informed consent and shared medical decision making. The program requires a mechanism for ongoing evaluation and its processes. In addition, there must be a single “strong entity” within the state or region that accepts responsibility and ownership for the Program.

The Form and it’s Requirements

Treatment provided requires a specific medical order based upon the patient’s goals of care and their preferences. POLST offers three choices. First, Comfort Measures Only means care that would relieve pain and suffering. The medical orders “explicitly state in the medical orders that comfort measures are always provided.” (www.polst.com ) The patient is to be transferred if “comfort needs” cannot be provided. Second, the choice is “Limited Additional Interventions” that offer comfort measures as well as IV fluids and antibiotics. This option includes a choice to be transferred to an acute care setting only if suffering could not be relieved at home. The third choice is that of “Full Treatment” and includes the Comfort Measures, IV Fluids and antibiotic interventions as well as CPR and intensive care if needed. The orders must be signed and dated.

To protect the patient’s wishes PRIOR to emergency intervention, requires POLST. For more information regarding this subject, go to www.POLST.com or www.ohsu.edu/polst

The Form must provide explicit direction as to resuscitation as well as patient preferences if they become pulseless or apneic. The Form must also include what the patient does NOT want including ICU, acute care, long term care, etc.

The Form must include the state of coverage. It is to be transportable so the patient may carry the Form within a state or region. The Form also clearly identifies a transfer option in case a patient’s comfort measures cannot be maintained in the present setting.

Posted in Advance Directives, Home Health, Physician Orders, POLST, Teaching/Education | 1 Comment »