Care Plan Oversight (CPO) is a billable service for an attending physician that supervises the care of a patient who is enrolled in a Medicare certified hospice program. The service is billable only if the service provided accumulates to 30 minutes or more in a calendar month, no other physician has been paid for the service and the CPO is personally furnished by the physician who bills for them. Also, the physician must have furnished a service which requires a face to face encounter with the patient at least once during the preceding six month period of the CPO billed month.
Services that constitute CPO:
- Activities to coordinate care
- Time spent reviewing:
- laboratory or other diagnostic studies,
- reports, treatment plans, or study results, except for initial interpretation of results
- Discussions with a pharmacist by telephone or face to face.
- Communication with other healthcare professionals involved with the patient’s care (face to face or telephone).
- Making medical decisions.
- Documenting the service provided. Include the date, service and time spent. Documentation must be maintained in the patient’s chart.
- Adjustment of medical therapies.
- Complex and multi-disciplinary modalities that require physician development and revision.
Billing Instructions: (It is not necessary to send documentation with the billing but it must be in the patient’s chart.)
- Must have billed for a face to face encounter in the preceding six months (Codes 99201-99236 and 99281-99357 are acceptable prerequisites).
- Bill Medicare Part B
- Bill on HCFA Form 1500
- Use CPT Code G0182
- Hospice of Texas' Medicare Provider # is 451596. (Please list it on HCFA 1500, item 23).
- In the remarks field the physician must indicate "Dr._________ is the attending physician and not employed by the hospice".
In 2004, the National Average payment was $124.86 per patient, per month.
Billing Successfully:
- Make sure the physician uses the same terminal diagnosis as Hospice of Texas uses.
- Make sure the physician is designated by Hospice of Texas as the attending physician on the Notice Of Election form (NOE).
- Make sure the dates of service are the first and last day the care plan services were provided, not the first and last day of the month.
- Make sure physician bills only one month of service per line item, only once per calendar month and claim is not submitted until the end of the month in which service is performed.
To make a referral or for assistance with CPO, please call:
Hospice of Texas (409) 832-4582 or Toll Free (800) 550-7476
