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Many physicians are embracing the old-fashioned house call of late, some for the great individual satisfaction of the very personal care they can render and others noting the increase in reimbursement that Medicare has provided since May of 2000. Due to a very strong campaign by the members of the American Academy of Home Care Physicians, Medicare has made it much more desirable from a financial standpoint for doctors to visit patients at home. As long as guidelines of medical decision-making are followed and proper documentation is provided, MD's can expect up to $229 based on the 2002 Medicare fee schedule in New Jersey for an initial home visit for a 99345 call to a patient (initial visit, new patient, medical decision making high, history and exam extended and face-to-face time 90 minutes). Follow-up visits for established patients are also well reimbursed.

There are several issues to consider before undertaking home visits, a few of which are discussed here.

The physician making house calls must be well organized, because travel time is included in the reimbursement rate. Adding home care to your practice can be a full-time or part-time endeavor. Important to note is that Medicare is explicit in its language that patients need not be homebound.

In 2001, Medicare clarified the difference between a home visit and visits to domiciliary facilities (a facility that provides room and board for an extended time, e.g. adult-living facilities). Visits to the latter are reimbursed at a slightly lower rate.

It is important to document that the home visit is necessary. Document that "leaving the home would require a considerable and taxing effort."

On another note, some physicians have reported that their malpractice insurer was willing to cut their rates after the actuary calculated that your in-office volume was reduced to house calls and that your malpractice exposure is lower with the geriatric population.

Lastly, some physicians work as employees for house call corporations and in this setting need to go through credentialing processes, have proof of malpractice insurance (not an issue in New Jersey because it is required by law) and even undergo urine drug screening before getting on board.

Blair Beltzer, MD, is a Consultant with the Healthcare Services Group at Amper. He is a partner of a family medicine practice and has particular expertise in providing clinical, coding and documentation, revenue cycle and regulatory services. Contact Blair at 732-287-1000, ext. 301.