Question about Home Health Annual Wellness Visit medicare

[nursing90504]

Hi Everyone,

I am a new NP and was just recently offered a job at a home health agency in California. I also work part-time at a family clinic. I have all my credentials like NP furnishing, DEA, AANP certification, etc. The agency wants me to perform these medicare "wellness checks"

I just recently started to research on home health and I started to get questions about medicare billing. Do I need need to sign up to be "medicare certified" or will the stuff I do be billed "incident to" to my supervising physician?

Also I read that in order to bill incident to in some cases for home health, the doctor has to be at the house as well.... So for all the NPs that work in home health

1) Are you all medicare certified?

2) Do you know if the stuff you do is billed under your name or the physician? If its under the physician, isn't it medicare fraud cause the rules for incident to in homes are so strict? (There is no way a doctor would be at EVERY house watching the NP....thats just redundant)

[NRSKarenRN, BSN, RN]

There is no Medicare "wellness check" payment under the Medicare Home Health benefit. Medicare Home Health regulations permit billing for home health services provided by Home Health agencies ordered by physicians who are Medicare certified only, not NP's.
Medicare Benefit Policy Manual, Chapter 7 - Home Health Service

Certifying Patients for the Medicare Home Health Benefit

Nurse Practitioners can bill as incident to your collaborating physician under regular Part A+ B payment only.

Medicare Wellness benefit is billed under Medicare Part B:

https://www.medicare.gov/coverage/yearly-wellness-visits

Yes you will need to have a Medicare Provider number and NPI number. See: How Does a Nurse Practitioner Obtain a Medicare/Medicaid Number for Billing Purposes?

CMS internet enrollment is thru PECOS System:: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/downloads/suppliers.pdf

I'd be very wary of a home health agency asking you to perform annual wellness visit unless agency's client is a patient of you and your collaborating physician. Even if the HH agency bills under Medicare Part B for home care, I don't think they can bill for the Wellness visits; billing would be done by your practice.

National Government Services http://www.ngsmedicare.com is the Medicare Home Health Intermediary for California home health providers you can contact them for confirmation.