Care Plan Oversight

Care plan oversight can be rather confusing to the general public.  Our goal at Total Home Health is to provide you with the information you need to understand how CPO may affect your experience with the home health services we provide.  Care plan oversight (CPO) refers to the physician supervision of patients under either the home health or hospice benefit where the patient requires complex or multi-disciplinary care requiring ongoing physician involvement.  Medicare does not pay for care plan oversight services for nursing facility or skilled nursing facility patients.

You may wonder if the services you are planning on receiving will be covered under your current benefit package.  The following are requirements to determine whether or not you will qualify related to the services provided to you:

ü  The client (beneficiary) must require complex or multi-disciplinary care modalities that require ongoing physician involvement in your unique plan of care.

ü  Beneficiary must be receiving Medicare covered home health or hospice services during the period in which the care plan oversight services are furnished.

ü  The physician who bills CPO for your services must be the same physician who signed your home health plan of care.

ü  Your physician must furnish at least 30 minutes of CPO within the calendar month for which payment is claimed from you, and it must be determined that no other physician has been paid for CPO within that same calendar month for your services.

ü  Your physician must have provided a physician service to you that required a face-to-face encounter within 6 months immediately preceding the provision of the first CPO service.

ü  The CPO that is billed must not be routine post-operative care that was provided to you.

ü  The CPO services must be personally furnished by the physician who bills them; Services provided “incident to” a physician’s service do not qualify as CPO and do not count toward the 30 minute requirement.

ü  If End-Stage Renal Disease is a condition you are burdened with, your physician may not bill CPO during the same calendar month in which he or she bills the ESRD for the same client. 

Listed above are the requirements that will determine whether or not your benefits allow you to qualify for CPO services.  Now that you know what is required you may wonder, “Which services qualify and which services do not qualify for CPO?”

Services that do qualify for CPO benefits include, but are not limited to:

·      Review of charts, reports, treatment plans, lab results, and any other tests results that were not ordered during the face-to-face encounter that qualified you for CPO.

·      Calls to other health care professionals involved in care of the patient outside of the office.

·      Team conferences regarding your treatment plan.

·      Telephone calls/discussions with the pharmacist about medication therapies.

·      Medical decision making.

Services that do NOT qualify for CPO benefits include, but are not limited to:

·      Calling Home Health Agencies or patients/families.

·      If your provider calls you or your family to do something such as medication or treatment.

·      Time your physician takes to call in prescriptions to pharmacy.

·      Travel time should not be included.

·      Time that is spent on the day of hospital discharge to manage the discharge plan.

The professional staff the make up the Total Home Health team abides by the criteria mentioned above to incorporate CPO into our home health programs for Medicare reimbursement according to your benefits and qualifications.  Review your benefits today and feel free to discuss this with our team at your discretion so that we can answer any unanswered questions for you!