Medicare Claims for Hospice Beneficiaries

As reiterated in the WPS Medicare Part B Legacy eNews, Medicare beneficiaries who elect hospice care, forego their rights to Medicare Part B payments for services related to treating and managing their terminal conditions, unless the services are provided by an attending physician. An “attending physician” is defined as a physician who is a doctor of medicine, doctor of osteopathy or a nurse practitioner who has been identified by the beneficiary, at the time hospice care has been elected, as having the most significant role in determining the delivery of that beneficiary’s medical care. Those professional services provided by the attending physician that are reasonable and necessary for treating and managing the beneficiary are not considered hospice services. Depending on the attending physician’s relationship with the hospice, either Medicare Part A (“Part A”) or Medicare Part B (“Part B”) will be billed for the attending physician’s services.

For an attending physician who does not furnish the services under an arrangement with the hospice, the attending physician’s services are billed under Part B with a GV modifier indicating that the attending physician is not employed or under a payment arrangement with the hospice. However, for an attending physician who has a payment arrangement with the hospice, then the attending physician’s services are billed by the hospice to Part A. See also HLP blog discussing the recent OIG report on this topic.

For more information, please contact Abby Pendleton, Esq. or Jessica L. Gustafson, Esq. at (248) 996-8510 or (212) 734-0128 or visit the Hospice specialty page on the HLP website.