Resources for Physicians

Home Health for Patients with Pyschiatric Diagnoses

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The National Hospice and Palliative Care Organization is making it easier for families to search for hospice providers through a new resource tool.

The National Hospice and Palliative Care Organization is making it easier for families to search for hospice providers through a new resource tool.

Are your psychiatric patients driving up readmission numbers? Home health care may be an answer.

Medicare beneficiaries with severe mental illness (SMI) have complex health needs, often a co-occurring physical health condition, and utilize high volumes of services. In fact, Medicare spends five times more on beneficiaries with severe mental illness and substance abuse disorder than on similar beneficiaries without these diagnoses, reports the SCAN Foundation.

Often SMI affects a patient’s adherence to treatment plans, especially if those plans are from various medical providers across settings. The result? Exacerbations that require high-cost services.

The all-cause 30-day readmission rate for patients with schizophrenia and other psychotic conditions (and who have a primary expected payer of Medicare) is 23.7 percent, according to the Agency for Healthcare Research and Quality. Under all-cause 30-day readmissions, the readmission rate is 24.2 percent for personality disorders and 26 percent for screening and history of mental health and substance abuse.

How can home health care help?

Psychiatric diagnoses most likely qualify for Medicare home health. Home health care services integrate behavioral health with skilled nursing to positively impact quality, costs and outcomes. Psychiatric patients don’t have to adhere to the typical homebound criteria requirements.  Indeed, they may have no physical limitations and still qualify for home health care.

Homebound criteria applied to psychiatric patients:

*Illness is manifested by a refusal to leave the home (e.g., severe depression, paranoia, agoraphobia).

*Due to illness it would be unsafe for the patient to leave the home (e.g., hallucinations, violent outbursts).

*Patient is blind or senile and requires assistance in leaving the home (includes patient with dementia who the physician deems is unsafe to be outside of home without supervision).

Also, homebound status is NOT affected by frequent absences from the home to receive therapeutic, psychosocial or medical treatment that can’t be provided in the home (adult day care, group therapy, etc.).


Can a Physician’s Assistant Bill for G0180 Under CPO?

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Question: Can a physician’s assistant (under supervision of an MD) bill for G0180?

Answer: Certification G0180 is the initial certification of a patient for Medicare-covered home health services. This code is used when the patient has not received Medicare-covered home health care for at least 60 days. The work this certification process requires includes: ordering the plan of care, signing the 485, and documenting the face-to-face encounter. Only physicians are allowed to bill for initial Certification and Recertification billing, however physician assistants, as well as nurse practitioners, may provide care plan supervision (G0181/G0182) services if they meet certain criteria. Physician assistants and nurse practitioners get reimbursed at 85 percent of an MD scheduled rate.


CPO Reimbursement Rates

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Question: Do you know where I can find the reimbursement rates by state for CPO?
Answer: Amedisys has published a useful guide about care plan oversight, which includes reimbursement rates by state and region. To download this guide, go here.