Reimbursement Hospice

Ensuring Seamless Reimbursement for Hospice Patient Care

When you entrust your patient to Hope Hospice, ensuring continuity of care is paramount. As the attending physician, you have the option to continue overseeing your patient's care and billing Medicare Part B for visits and Care Plan Oversight. This allows you to maintain a direct role in your patient's journey.

Alternatively, if you prefer not to continue as the attending physician, your patients will seamlessly transition to our dedicated Medical Directors service. Rest assured, they will receive exceptional care from our experienced clinical team at Hope Hospice.

 

General Billing Information

  • Physician Bills Medicare Part B using existing CPT and ICD-9 codes
  • Medicare pays 80% of allowable fee schedule
  • If a physician other than hospice patient’s attending bills Medicare Part B, the bill likely will be denied unless the care is unrelated to the patient's terminal illness (in which case the physician should indicate on the bill)
  • Modifiers for billing:
    • GV modifier should be used if the service is related to the hospice diagnosis
    • GW modifier should be used if the service is non hospice related
    • Q5-used in conjunction with GV or GW modifiers when another physician in the practice is covering for the patient’s attending physician
    • Q6- Used in conjunction with GV or GW modifiers when another physician in a different  practice substitutes for the patients attending physician
  • Must Include the following on the bill:
    • Patient’s name as it appears on the Medicare card
    • Provider number of the patient’s hospice provider
    • Medicare provider number on the claim
    • Hospice election date
    • Patient Demographic information
    • Patient’s hospice diagnosis
    • Patient’s HIC number as it appears on the Medicare card

Billing for Hospice Care Supervision (Care Plan Oversight)

  • Attending physician qualifies for reimbursement when spending more than 30 minutes per calendar month on phone calls, chart reviews and coordination of care for a hospice patient
  • Does not apply if patient resides in nursing home
  • Only the designated attending for a hospice patient may bill for Hospice Care Supervision
  • Billed to Medicare Part B, using HCPCS code G0182, which pays 80%
  • Physician must have had face-to-face encounter with patient in previous six months

  

Sources: https://www.cgsmedicare.com/partb/pubs/news/2014/0514/cope25747.html

 

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