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Hospice is a Face, Not a Place

Medicare Billing

When Your Patient is on Hospice: Reimbursement for Physician Services

Physicians may hesitate to refer patients for hospice care because of a misunderstanding about loss of reimbursement.

Confusion centers around three issues: 1) how to bill for services, 2) who to bill, and 3) which services qualify for reimbursement.

We realize that this can be confusing, and so we are happy to answer your questions. Please contact Accounts Receivable at 352.854-5237 or by email (cjoyner@hospiceofmarion.com).

How to Bill

The Centers for Medicare & Medicaid Services (CMS), a Federal agency within the U.S. Department of Health and Human Services, administers the Medicare program. The Hospice Manual, a detailed guide to billing for hospice services, on the CMS Web site.

Who to Bill

  1. Pre-authorization is required for any treatment, once the patient is in our service
  2. All attending physician services must be billed directly to Medicare Part B. If billed with the same diagnosis as hospice, you must include the GV modifier. Please do not bill these services to Hospice of Marion County, as we cannot provide reimbursement.
  3. All consulting physician services should be billed directly to Hospice of Marion County with the referring hospice physician’s name.
  4. Hospice of Marion County can only reimburse for services that have been authorized in the patient’s Hospice Plan of Care. The Plan of Care is a comprehensive document detailing: a) all services provided for the patient and b) services authorized for the patient.

 

Attending Physician Services Qualified for Reimbursement

Care Plan Oversight:
Every Hospice patient has a Plan of Care, a comprehensive but individualized plan followed by the hospice team members, as well as the family members and caregivers. Each member of the hospice team has access to this plan, which is continually updated.

The attending physician must sign off on any change that the hospice team makes to the Plan of Care. You can bill for the following with a GV modifier: :

  • All the time spent providing this oversight, including phone consultations.
  • Visits made to treat the patient’s hospice diagnosis in any setting—hospital, nursing home, or in the home—where the patient is receiving hospice care.

Care Unrelated to the Hospice Diagnosis:
If a Hospice patient asks you to treat a medical problem unrelated to the hospice diagnosis, you can still bill Medicare Part B with a GW modifier.
While the patient is receiving services under the Hospice Medicare Benefit, coverage for any services unrelated to the hospice diagnosis remains in effect: There is no loss of coverage.

 

Services Not Covered by the Medicare Hospice Benefit

Under the Medicare Hospice Benefit, Medicare will not pay for any curative services directed at the patient’s life-limiting illness.