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Carriers Should Crack Down On CPO, OIG Says


If your physicians are overseeing the care of home health patients, you could find the carriers looking over your shoulder in the wake of a new report.

Two Texas physicians received $15,897 in wrongful reimbursement for 236 care plan oversight (CPO) services on nine claims, the HHS Office of Inspector General said in a new audit report (A-06-04-00083). The physicians shouldn't have received reimbursement for any of these services, because they didn't actually provide 230 of them and lacked supporting documentation for the remaining six, the OIG insisted.

Physicians can bill for CPO (G0179-G0182) only once per patient per month, the OIG notes. And physicians must spend at least 30 minutes on CPO to bill for the service. When these physicians billed for those 236 services, Part B carrier Trailblazer Health Enterprises didn't have edits in place to allow only one CPO service per claim, but Trailblazer has added those edits since then.

The OIG recommended that Trailblazer examine more recent claims to see if its edits are working, and educate physicians on the requirements for CPO services. Trailblazer agreed with both recommendations.