Physician Information

Like the early Sisters of St. Joseph who went into the community to meet the needs of the people they served, our home care services reach out to our community to care for our dear neighbors. This mission is not possible without the partnerships we share with the physicians we are privileged to work with.

We value the relationships we have developed with our care providers. These resources are available to assist you in the work that you do in caring for patients in the communities we serve. If you need additional assistance, please do not hesitate to contact us at 714-712-7110.

Download Physician Referral Form

 

The following are the required elements for the current regulations for the home health Face to Facedocumentation.

1. Please send your progress note, Discharge Summary, or History and Physical for the encounter.

  • Encounter must occur no more than 90 days prior to or not more than 30 days after the Home Health Start of Care
  • Must be performed by a physician with PECOS enrollment or an NPP who saw the patient. The document must be signed and dated by the physician.
  • Must show that patient seen for the main reason that home health is needed.

2. Other items required:

  • What services ordered
  • What is reason for the services

3. Home bound criteria must be noted that gives:

  • what caused patient to be home bound
  • what assistance does the patient require. Does it include assistance of a person, device or both?
  • what is the effort required for the patient to leave home. Needs explanation.

4. The document will need to have your signature and date.

5. Hospital or other post-acute facility visit documents may be used to meet the encounter information.

  • We will send those documents for you to retain in the patient’s medical record. CMS may request these records from you in the event of an audit or additional documentation request.

For any questions please contact: St. Joseph Home Health nurse Face to Face reviewers.

Download Face-to-Face Requirements

Download Physician Encounter Face-to-Face Documentation

References

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c07.pdf
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/se1405.pdf
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1436.pdf

 

 

When and how do we use the GV and GW modifiers when billing for patients that are under the care of hospice?

The GV modifier is placed in field 24D on the HCFA 1500 claim form. This is the modifier used when a physician is the Attending Physician for a hospice patient and not associated with the hospice in any way (employed, contracted, or volunteering), but who is providing a service that is related to the diagnosis for which a patient has been enrolled into hospice.

The GW modifier is used when a physician is the Attending Physician for a hospice patient and not associated with the hospice in any way (employed, contracted, or volunteering) who is providing a services that is not related to the diagnosis for which a patient has been enrolled onto hospice. Source: NHPCO NewsBriefs, Volume 6, Issue 41 (October 14, 2004)

Are you aware that you can receive reimbursement from Medicare through your MAC for Transitional Care Management?

Some of the components to meet criteria for a Transitional Care Management office visit are provided. We have also provided the web sites you can go to learn additional information.

See the References at the end of this short list of information.

Components of Transitional Care Management:

  • Patient discharged from an inpatient hospital setting
  • Patient has gone “home” to residence, Board and Care or Assisted Living facility.
  • Timing: Within 30 days from the inpatient discharge, the following must be furnished:
  • Direct contact with the patient within 2 business days of discharge.
  • A face to face visit with physician or NPP within 7 days after discharge OR within 14 days after discharge. (This visit is not to be reported separately.) Include the required Medication Reconciliation and Management portion by the date of the face to face visit.
  • Certain other non-face-to-face services may be provided by either a physician OR other licensed clinical staff. (eg. identify available community and health resources, teach beneficiary and/or caregivers about activities of daily living or self-management, communicate with home health or community services used by beneficiary).

Billing for Transitional Care Management Services:

  • CPT Code 99495 with Face to Face visit with Moderate Complexity Medical Decision Making within 14 day of discharge-paid at approximately $187.00.
  • CPT Code 99496 with High Complexity Medical Decision Making Face to Face visit within 7 days of discharge-paid at approximately $262.00.

Moderate Complexity Medical Decision Making:

  • Multiple diagnoses or management options,
  • Moderate amount and /or complexity of data to be reviewed,
  • Moderate risk of significant complications, morbidity, and/or mortality.

High Complexity Medical Decision Making:

  • Extensive number of diagnoses or management options
  • Extensive amount and/or complexity of data to be reviewed,
  • High risk of significant complications, morbidity, and/or mortality.

Download this Page for your Reference

 

References:

  • https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Transitional-Care-Management-Services-Fact-Sheet-ICN908628.pdf
  • https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/Downloads/FAQ-TCMS.pdf