WELCOME TO PHYSICIAN’S CORNER

My name is Dennis Heide and I am a Physical Therapist and the Administrator for Pinnacle Home Healthcare, Inc. On behalf of our staff, I am personally writing this letter to introduce ourselves to you and your patients. We very much desire to serve you and your patients with any and all of your home health care needs.

Pinnacle Home Healthcare, Inc. is owned and operated by Clinicians with over 75 years of combined experience in health care. Our mission is two fold: First, we will commit ourselves to providing patients with the best home health care possible based on the highest ethical and professional standards. Second, we will strive to be the Central Florida leader in the provision of quality home health care services.

We desire very much to be able to serve you and your patients. When you have patients requiring home health care please contact us and we will make your patient’s health our highest priority!

Following are a few tools we think you will find helpful in caring for your patients receiving home health care.

1.)    Indicators of need for home health care.

2.)    Care Plan Oversight instruction sheet.

3.)    Insurances currently accepted.

4.)    New patient referral form.

ý            Require complex home treatments like IV medications, wound care, enteral feedings, etc.

ý            There is a need for nursing, physical occupational speech or respiratory therapy, social services or home health aide

ý            You have difficulty following your physician’s recommended treatment at home

ý            Have a need for further instruction on medications, diet, treatments, etc.

ý            Have a history of multiple hospital admissions and/or unstable medical history

ý            You have been “readmitted” for a diagnosis treated by hospitalization in the previous three months

ý            You were getting along “OK” before you went to the hospital but now are significantly less independent

ý            Have a potentially life threatening, severely incapacitating, or terminal diagnosis

ý            Have received a variety of skilled nursing and ancillary services up to the date of hospital discharge

ý            Have a new diagnosis

ý            Have new or adjusted medications

ý            Experienced a recent decline in functional status

ý            You require medical evaluation and observation

ý            You have unstable problems such as blood pressure, blood sugars, pain control, etc.

ý            Are returning home from a stay at a rehab, skilled nursing facility or assisted living facility and need continued care

ý            Are a resident at an assisted living, retirement or continuing care facility and have skilled care needs

ý            NEED HELP?  JUST CALL US AND WE’LL MAKE YOUR HEALTH OUR HIGHEST PRIORITY!

CARE PLAN OVERSIGHT (CPO) BILLING CRITERIA

FOR MEDICARE HOME HEALTH PATIENTS

PHYSICIAN MUST CONSIDER THE FOLLOWING PRIOR TO BILLING CPO SERVICES:

1. Patient has received Medicare covered home health services.
2. Physician has devoted 30 minutes or more to supervision of the patient’s care in a given month.
3. Physician has furnished a service requiring face-to-face contact with the patient at least once during the 6-month period before the month for which care plan oversight payment is first billed.
4. Physician does not have a significant financial or contractual relationship with the Home Health Agency.
5. Physician has the provider number of the patient’s Home Health Agency.
6. If physician is billing for CPO services during a postoperative period, the physician must document in the patient’s medical record that the CPO services are unrelated to surgery.
7. Physician is the one and only attending physician to bill for CPO for the patient during a calendar month.
8. Physician who signed the plan of care and personally furnished the services will be the one who can bill CPO to Medicare.
9. Physician is not billing for Medicare ESRD capitation payment and CPO for the same beneficiary during the same month.

THE FOLLOWING ACTIVITIES WILL QUALIFY AS CPO SERVICES:

1. Activities to coordinate services (if the coordination of the activities requires the skill of a physician).
2. Documenting the services provided which includes writing a note in the patient chart describing service provided, decision making activities performed, and amount of time spent performing the qualifying CPO services.
3. Medical decision making performed.
4. Review of charts, reports, treatment plans, or lab or other test results except for the initial interpretation or review of lab or test results that were ordered during or associated with a face-to-face encounter.
5. Telephone calls with other health care professionals (not employed in the same practice) involved in the care of the patient.
6. Team Conferences (must document time spent per individual patient).
7. Telephone or face-to-face discussions with a pharmacist about pharmaceutical therapies.

THE FOLLOWING ACTIVITIES WILL NOT QUALIFY AS CPO SERVICES:

1. Getting and /or filing the chart, dialing the phone or time on hold (these activities do not require physician work or meaningful contribution to the treatment of the illness or injury).
2. Informal consultations with health professionals not involved in the patient’s care.
3. Initial interpretation or review of lab or study results that were ordered during or associated with a face-to-face encounter.
4. Low intensity services included as part of other E&M services.
5. Preparation or processing of claims.
6. Staff time, i.e. time the nurse practitioner, physician’s assistant, clinical nurse specialist, or other staff spends getting or filing charts, calling Home Health Agency’s patients, etc.
7. Telephone call to patient or family, even to adjust medication or treatment.
8. Telephoning prescriptions in to pharmacists (not considered a physician service; does not require a physician to perform).
9. Travel time.

                                                CPO MEDICARE REIMBURSEMENT CODES

INSURANCE CONTRACTS:

We are glad to inform you that we are now a listed provider for the following insurance companies:

Medicare

Beechstreet

            Healthnet

            Mutual of Omaha

            Conseco

            National Health Insurance

            (And any Beechstreet managed insurance companies)

Tricare-Champus

United Healthcare

Pinnacle Home Healthcare, Inc.

7041 Grand National Drive

Orlando, FL 32819

Tel: (407) 351-6330  Fax: (407) 351-6303

Patient Name: ______________________________ DOB:___________

Address:__________________________________________________ City/zip:_____________________

Phone #:_________________ Medicare/Insurance #________________

Admitting Diagnosis:

(Primary)_________________________________________________________________

(Secondary)_________________________________________________________________

Orders: Refer to Pinnacle Home Healthcare, Inc. for home health evaluation and assessment.

SPECIFIC ORDERS: __________________________________________________________________

__________________________________________________________________

__________________________________________________________________

Supplies Needed:

_________________________________________________________________

__________________________________________________________________

Physician Signature: ___________________________________________

Physician Name: ______________________________________________

Date: _______________________ Time: ________________________

Orders Received By: ____________________________________________

Date: _______________________ Time: ________________________

PHHI-68

Form: revised: 061604