decisionhealth Newsletters, Part B News - 2015 Issue 12 (December)
Setting up patient and her nurse for home care? Nice, but you can’t charge
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Article Overview
This premium Q&A addresses a Medicare billing scenario involving a patient, an outside nurse, and provider supervision during initiation of home therapy. It is aimed at physicians, coders, billers, and practice managers who need to understand whether such encounters are separately payable, what level of documentation may matter, and what non-insurance reimbursement ideas may be considered. The article focuses on general coverage and billing principles rather than a specific code set.
Why This Topic Matters
These situations can look like billable office services even when no separately payable medical service was provided. Understanding the distinction helps practices avoid improper claims and identify when documentation may support a different billing outcome.
What You Will Learn
- How to evaluate whether a supervised visit related to home care is separately billable
- What role documentation can play in determining whether an E/M service was provided
- What general non-medical reimbursement considerations may come up in this type of arrangement
- Why provider supervision alone may not create a payable Medicare service
Who Should Read This
- Physicians
- Medical coders
- Medical billers
- Practice managers
- Revenue cycle staff
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