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Physician Billing for Medicare Hospice Patients

Amber Bukowski, March 22, 2021March 22, 2021

To understand the physician billing modality for hospice patients, you must first understand that hospice care, unlike other Medicare processes, is a patient-centered benefit. When a patient chooses hospice, all options are based on patient-centered care and preferences Small Practices Medical Billing Services.

Upon referral to hospice care, the patient leaves curative treatment for terminal diagnosis. The treating physician and the hospice caregiver team medical or medical director must certify that the patient has a “medical prognosis according to which his life expectancy is six months or less, if the disease runs its normal course.”

Patient care not related to terminal diagnosis continues to be billed directly to Medicare using the appropriate billing codes.

Physician service categories

Once a Medicare patient elects the hospice benefit, the Centers for Medicare & Medicaid Services (CMS) directly pays for care related to the terminal diagnosis to the hospice provider. Physician services are billed by the hospice according to the type of service provided.

Treating physician services

The hospice treating physician is an MD, DO, PA, or NP and may or may not be an employee of the hospice provider.

An interdisciplinary team of hospice caregivers includes a physician who oversees various aspects of patient care. In addition, a hospice patient may choose to have their primary care physician (PCP), other physician, or a physician’s assistant / nurse practitioner be their treating clinician.

If the chosen clinician agrees to be the hospice patient’s treating physician, the terminally ill treatment that the clinician provides may be billed directly to Medicare. Only a treating physician who is not an employee of the hospice provider can bill Medicare Part B for hospice care using the CPT code E / M.

If the hospice doctor is the treating doctor, all services related to the terminal illness are billed to Medicare by the hospice, not directly by the doctor. The hospice team informs the patient’s PCP / other clinician about the patient’s condition and contributes to the dialogue, but does not undertake any direct care related to the terminal diagnosis.

Services of the doctor in charge of the follow-up

The treating MD or DO (which cannot be PA or NP) may decide to be the patient’s follow-up physician, responsible for providing the hospice care itself, i.e. writing the orders, working alongside the nursing staff of the caregiver team hospice and give directions.

Non-treating physician services (consultation)

In the event that the patient needs services related to the terminal illness from a physician other than their treating physician, this specialty physician must sign a contractual agreement with the hospice for their services. Payments for treatment or care services related to the patient’s terminal illness and provided by a specialist who has a contract with hospice are the responsibility of the hospice, not Medicare Part B or Part A.

Administrative activities

Administrative or supervisory activities include creating, reviewing or updating care plans, supervising the implementation of care, etc. These services are provided by a hospice-employed medical or medical director and are included in the hospice fee. In other words, they are covered by Medicare hospice benefits. Administrative activities are not billed separately.

Health

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