How do I bill for hospice services?
The following is an excerpt from the “Part B Answer Book” CD-ROM.
Hospice Care: Overview
If one of your patients has a
terminal illness, with about six months
or less to live, your patient can
choose either standard Medicare coverage or
hospice care. When someone chooses hospice
benefits, he/she may continue to rely on a private doctor and at the same time
make use of the hospice physician.
As of Aug. 5, 1997, hospice care is available for two 90-day periods and an
unlimited number of 60-day periods during the hospice patient’s lifetime.
Hospice services (including those of the hospice physician) are billed under
Part A to the intermediary, which pays 100% of Medicare’s approved charges.
Services for an attending physician not connected to the hospice are billed to
the carrier. Such services by an attending physician should be coded with the
GV modifier
What Medicare Will Pay For
Medicare hospice benefits pay for treatment designed to keep your patient
as comfortable as possible. Attempts to cure the
condition that brings your patient to
the hospice don’t fall under this
particular benefit. (The carrier’s medical staff makes the decision about what
is and isn’t palliative care). However, you can bill Medicare for curative
treatment that isn’t part of the terminal condition, just as you ordinarily
would, whether you’re the patient’s private doctor or you work for the hospice.
Once hospice coverage is elected, the patient isn’t eligible for Medicare Part
B services related to the treatment and management of his terminal illness. One
big exception is that professional services of an attending physician may be
billed under Part B. To qualify as an attending physician, the patient must
identify at the time he elects hospice coverage, the physician (doctor of
medicine or osteopathy) who has the most significant role in his/her medical
care. The attending physician doesn’t have to be employed by the hospice, and
the patient still may be treated by hospice-employed physician.
Two Paths for Reimbursement
You can bill the carrier for treatment and management of a hospice patient’s
terminal illness and get paid 80% of the Medicare fee schedule amount (plus the
co-insurance and deductible) – as long as you are the attending physician, and
you don’t furnish the services under a payment arrangement with the hospice.
When billing Medicare Part B, make sure to indicate the following in item 19 of
the Form CMS-1500: “Hospice patient. Dr. ___________ is the attending physician
and is not employed by the hospice.”
However, if you furnish the services
related to a hospice patient’s terminal
illness under a payment arrangement with the hospice, such
services are considered hospice services and are billed by the hospice to the
fiscal intermediary. (You don’t bill the carrier). Hospice physician services
are paid by the hospice intermediary at 100% of Medicare approved charges.
In order to bill properly beginning
December 21, 2000, a physician must
certify that the patient is terminally ill, which is
defined as having a medical prognosis of a life expectancy of six months or
fewer if the illness runs its normal course
Revoked or Exhausted Benefits
If the patient’s hospice benefits have
been revoked or exhausted, the carrier
will pay all medically necessary physician services (even to
hospice employed physicians) at the regular fee schedule amount .
No comments:
Post a Comment