Billing Claims Involving Hospice Coverage

When a beneficiary elects hospice care, s/he waives any Part B coverage related to that hospice care except for services rendered by an “attending physician.” An attending physician is defined as either a doctor of medicine, doctor of osteopathy or a nurse practitioner who is identified by the beneficiary as having the most significant role in the beneficiary’s determination and delivery of medical care.

The beneficiary may designate and use an attending physician, who is not employed by the hospice, for professional services furnished in addition to the services of hospice-employed physicans. The professional services of an attending physician that are reasonable and necessary for the treatment and management of a hospice patient’s terminal illness are not considered hospice services. Provided he or she does not furnish the services under a payment arrangement with the hospice, the services of the attending physician are billed to Medicare Part B with the GV modifier– “Attending physician not employed or paid under agreement by the patient’s hospice provider.” If a substitute or locum tenens physician provides services, the services are billed by the designated attending physician under the reciprocal or locum tenens billing instructions by use of modifier GV in conjunction with either the Q5 or Q6 modifier. Payment is made to the attending physician or beneficiary, as appropriate, based on the payment and deductible rules applicable to each covered service. Services not related to the hospice patient’s terminal condition are coded with the GW modifier–“Service not related to the hospice patient’s terminal condition.”

If a private attending physician furnishes services related to a hospice patient’s terminal condition under a payment arrangement with the hospice, such services are considered “hospice services” and are billed by the hospice to Medicare Part A. Hospice physician services are paid by the hospice intermediary, Part A, at 100% of Medicare approved charges.

For more information, please contact Abby Pendleton, Esq. or Jessica L. Gustafson, Esq. at (248) 996-8510 or visit The HLP website.

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