Coding education makes MD relationship stronger

Physicians don’t always file for oversight

As your agency struggles to develop and maintain strong, lasting relationships with referring physicians, don’t forget that your expertise and experience in dealing with Medicare claims might be just what the doctor needs.

"Physicians are comfortable with familiar paperwork, and most physicians are not familiar with the paperwork required to document home care claims," says Peter A. Boling, MD, professor of medicine at Virginia Commonwealth University in Richmond, past-president of the American Academy of Home Care Physicians (AAHCP) in Edgewood, MD.

"Because they do not learn home care during their education and because there have been publicized cases of fraud with physician claims for home care oversight, many physicians are reluctant to file or don’t want to take the time to document," he says. "Home care certification and re-certification is the easiest money any physician can make," Boling says. The codes are simple and uncomplicated, he says. One thing that physicians must file correctly is the home health agency’s six-digit Medicare provider number.

Care plan oversight is not as simple, Boling admits. "Care plan oversight pays twice the amount of certification, but it does require more documentation," he says.

Because Medicare rules state that a patient requires 30 minutes or more of physician involvement during a month, only 10% to 20% of a physician’s home health patients will meet this requirement, he explains. For this reason, many physicians don’t document any activities that might be eligible for care plan oversight because they believe it is too time-consuming, he adds.

When physicians comment that documenting care plan oversight cases is too complicated, Albert deMartino, MD, medical director for the Visiting Nurse Services of Westchester in White Plains, NY, recommends that they take some time to develop documentation forms and make sure office staff members understand the coding for home health reimbursement.

"Each year I go through the list of our referring physicians and send a copy of the AAHCP’s Making Home Care Work in Your Practice booklet to physicians who refer more than 10 patients to our agency," deMartino says. (For ordering information, see list of resources at the end of this article.) "The booklet contains descriptions of the codes and a sample documentation form that can be placed in a home health patient’s chart," he explains.

"It is a simple, easy-to-read guide for physicians who certify or oversee home health patients, order durable medical equipment for their patients’ use, or make home visits," he adds.

While the home health agency cannot file the physician’s Medicare claim, deMartino points out that the agency can offer to educate the office staff and recommend processes that can make documentation simpler.

Whether you use a booklet or simply make the offer in a face-to-face conversation with the physician, offering to help the physician collect payment for services that are rendered is a positive step in an agency-physician relationship, deMartino says.

[For more information about physician coding and documentation for home care services, contact:

  • Peter A. Boling, MD, Professor of Medicine, Virginia Commonwealth University, P.O. Box 980102, Richmond, VA 23298. Telephone: (804) 828-5323. E-mail:
  • Albert deMartino, MD, Medical Director, Visiting Nurse Services of Westchester, 360 Mamaroneck Ave., White Plains, NY 10605. Telephone: (914) 682-1480. Fax: (914) 682-1477.

To order a copy of Making Home Care Work In Your Practice: A Brief Guide to Reimbursement and Regulations, contact:

American Academy of Home Care Physicians, P.O. Box 1037, Edgewood, MD 21040-1037. Telephone: (410) 676-7966. Fax: (410) 676-7980. Web site: Price of the booklet is $10 for members and $12 for nonmembers plus shipping and handling charges. Payment may be made by Visa or MasterCard. Orders can be placed by telephone or on-line.]