Hospice Care

August 28th, 2013 - Codapedia Editor
Categories:   Coding   Medicare   Modifiers  
0 Votes - Sign in to vote or comment.

Patients who sign up with hospice waive their rights to receive Medicare Part B services, and must look to the hospice organization to provide care related to the terminal illness.  The hospice provider receives a daily payment to care for the patient on hospice.  The patient’s own attending physician, (who is not an employee of hospice) designated at the time the patient signs up for hospice, may treat the patient.  

Any physician who is connected to the hospice may not bill Medicare Part B separately for the services, because the hospice is receiving a daily payment amount for the care.  The medical director of hospice may not bill Part B for any services provided to patients on hospice.  

Covered separately by Part B, is payment to a non-hospice physician, whom the patient designates at the time of hospice election, as their own physician, or in Medicare's words, the physician who "Is identified by the individual, at the time he/she elects hospice coverage, as having the most significant role in the determination and delivery of their medical care."  This physician may bill the patient for the treatment and management of terminal and non-related services.  

For the purpose of the hospice benefit, an attending physician means a professional who:

•    Is a doctor of medicine or osteopathy or

•    A nurse practitioner (for professional services related to the terminal illness that are furnished on or after December 8, 2003); and

•    Is identified by the individual, at the time he/she elects hospice coverage, as having the most significant role in the determination and delivery of their medical care.

The attending physician, that is, the patient’s own physician who is designated by the patient at the time of hospice election, uses a GV  or GW modifier on their claims. GV is defined as: “Attending physician not employed or paid under agreement by the patient’s hospice provider.”  GW is used to indicate that the service provided by the attending physician was not related to their terminal condition.

What about other physicians who may see the patient while they are on hospice?  According to the Medicare manual, Where the service is considered a hospice service (i.e., a service related to the hospice patient’s terminal illness that was furnished by someone other than the designated “attending physician” [or a physician substituting for the attending physician]) the physician or other provider must look to the hospice for payment.

Services provided by the patient’s own physician or Nurse Practitioner must be coordinated with the hospice physician.  If the patient’s own physician or NP is not available, a covering physician or NP or a covering locum may bill for the service, using the GV or GW modifier, in conjunction with the Q5 modifier for covering physicians or NPs or Q6 modifier for a locum physician.   (Billing under the locum tenens provisions is only allowed for physicians.)  Physician Assistants may not be the attending physician for hospice patients.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

CMS and HHS Tighten Enrollment Rules and Increase Penalties
October 1st, 2019 - Wyn Staheli, Director of Research
This ruling impacts what providers and suppliers are required to disclose to be considered eligible to participate in Medicare, Medicaid, and Children's Health Insurance Program (CHIP). The original proposed rule came out in 2016 and this final rule will go into effect on November 4, 2019. There have been known problems ...
Federal Workers Compensation Information
October 1st, 2019 - Wyn Staheli, Director of Research
When federal employees sustain work-related injuries, it does not go through state workers compensation insurance. You must be an enrolled provider to provide services or supplies. The following are some recommended links for additional information about this program. Division of Federal Employees' Compensation (DFEC) website Division of Federal Employees' Compensation (DFEC) provider ...
E-Health is a Big Deal in 2020
September 16th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
The new 2020 CPT codes are on the way! We are going to see 248 new codes, 71 deletions, and 75 revisions. Health monitoring and e-visits are getting attention; 6 new codes play a vital part in patients taking a part in their care from their own home. New patient-initiated ...
Chiropractic 2020 Codes Changes Are Here
September 9th, 2019 - Wyn Staheli, Director of Research
There are some interesting coding changes which chiropractic offices will want to know about. Are codes that you are billing changing?
Q/A: Is the Functional Rating Index by Evidence-Based Chiropractic Valid?
September 9th, 2019 - Wyn Staheli, Director of Research
Question Is the Functional Rating Index, from the Institute of Evidence-Based Chiropractic, valid and acceptable? Or do we have to use Oswestry and NDI? Answer You can use any outcome assessment questionnaire that has been normalized and vetted for the target population and can be scored so you can compare the results from ...
List of Cranial Nerves
September 3rd, 2019 - Find-A-Code
Cranial nerves are involved with some of our senses such as vision, hearing and taste, others control certain muscles in the head and neck. There are twelve pairs of cranial nerves that lead from the brain to the head, neck and trunk. Below is a list of Cranial Nerves and ...
So How Do I Get Paid for This? APC, OPPS, IPPS, DRG?
August 21st, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
You know how to find a procedure code and you may even know how to do the procedure, but where does the reimbursement come from?  It seems to be a mystery to many of us, so let's clear up some common confusion and review some of the main reimbursement systems.  One of the ...



About Codapedia by InnoviHealth Systems Contact Us Terms of Use Privacy Policy Advertise with Us

Codapedia™ by InnoviHealth Systems™ - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain) - Fax (801) 770-4428

Copyright © 2009-2019 Find A Code, LLC - CPT® copyright American Medical Association