Requirements for the Medicare Care Plan Oversight

Physicians giving health care for Medicare individuals within hospices and home health agencies have certain requirements to follow involving those patients under the Medicare Care Plan Oversight (CPO). Such requirements involve the development and revision of care plans, subsequent reports of patients' status reviews, adjustment of medical therapy and reviews of laboratory and other related studies.

Requirements

• CPO services have a time frame covering the period that the beneficiary receives Medicare-covered hospice care. The requirements for this CPO also include only those beneficiaries who require ongoing complex and multidisciplinary care needing constant physician involvement. Also, the physician who bills the CPO must be the same person who signed the hospice plan of care.

Unprovided Services

• Services not included under the CPO requirements for billing purposes include any medical time not falling within a 30-minute period, the time spent by staff filing charts and travel time. Physician time spent on the telephone submitting prescriptions to pharmacist will also not be considered, unless the conversation involves pharmaceutical therapies.

Billing

• Any care billed to the CPO must be filed under form CMS-1500 and billed to Medicare Part B. Under CPO requirements, no other service fees can be billed under this process. The billing has to be done after the end of the month when CPO service was given. It cannot be billed across calendar months. Only one unit of service can be shown per month. Since 2001, Medicare has established HCPCS code G0182 for billing CPO hospice as a result of revisions concerning certain definitions that the American Medical Association had made to the current procedural terminology codes.