Reimbursement for Services
If you as the physician have any questions about your reimbursement while the patient is open to Hospice, AMC Hospice Billing can be a resource for your office. Confusion centers around three issues:
- How to bill for services
- Who to bill
- Which services qualify for reimbursement
Please contact Cheryl McKay, Hospice Billing at (540) 332-4943 or cmckay@augustamed.com if you have questions not covered here.
How to Bill for Services
Who to Bill
All attending physician services must be billed directly to Medicare Part
B as you have always done. The attending physician will not be billing Hospice
for these services.
All consulting physician services need to be billed directly to AMC Hospice, but you must use the proper consulting code to qualify for reimbursement. If the wrong code is used, we cannot reimburse.
Please note: Hospice can only reimburse for services that have been authorized in the patient's Hospice Plan of Care. The Plan of Care is a comprehensive document detailing all services provided for the patient and services authorized for the patient.
Attending Physician Services Qualified for Reimbursement
Care Plan Oversight
Every Hospice patient has a comprehensive and individualized Plan of Care. The
attending physician must sign off on any change that the hospice team makes to
the Plan of Care.
You can bill for:
- Time spent providing this oversight (phone consultations, etc)
- Visits made to treat the patient's hospice diagnosis in any setting, hospital, nursing home, or in the home, wherever the patient is receiving hospice care
Care Unrelated to the Hospice Diagnosis
If a Hospice patient asks you to treat a medical problem unrelated to the hospice diagnosis, you can still bill regular Medicare. While the patient is receiving services under the Hospice Medicare Benefit, coverage for any services unrelated to the hospice diagnosis remains in effect. There is no loss of coverage.
Services Not Covered by the Medicare Hospice Benefit
- Will not pay for any curative services directed at the patient's life-limiting illness.
- Care not related to the terminal diagnosis is not covered under the Hospice Benefit. These would be covered by the routine Medicare benefit.
Links
The Centers for Medicare & Medicaid Services (CMS), a federal agency within the U.S. Department of Health and Human Services, administers the Medicare program. You can find detailed guides for hospice services on the CMS web site.
Publication
# 21 - The Hospice Manual *
Physician's
Information Resource for Medicare *
Medicare
Coverage Database - Disease Specific Guidelines *
* Links open a new browser window.