The attending physician can continue to bill Medicare Part B for professional services including office, home and inpatient visits. Laboratory studies, X-rays or other diagnostic tests necessary for proper treatment of the terminal illness are covered under the hospice per-diem rate.
Full Answer
Who can bill Medicare Part B for hospice care?
Only an attending clinician who is not employed by the hospice can bill Medicare Part B for hospice care using the CPT E/M code. If the hospice physician serves as the attending physician, all services related to the terminal condition are billed to Medicare by the hospice, not directly by the physician.
How does physician billing work for hospice patients?
To understand physician billing for hospice patients, first understand that hospice, unlike any other Medicare process, is a patient-based benefit. When a patient selects hospice, all the choices are based upon patient-centered care and preferences.
What happens when a patient elects hospice coverage?
When a patient chooses to elect Medicare hospice coverage, they waive all rights to Medicare Part B payments: Medicare can allow some services by the attending physician, nurse practitioner, or physician assistant. This resource provides an overview of Medicare payment when a patient elects their hospice benefit.
How do I add physician services to a hospice claim?
If the monthly hospice claim has already been submitted and processed (P B9997), an adjustment claim (type of bill 8X7) can be submitted to add the physician services. Enter the appropriate HCPCS code that correspond with the physician service provided.
What are the hospice modifiers for Medicare?
Hospice Modifier GW The GW modifier indicates that the service rendered is unrelated to the patient's terminal condition. All providers must submit this modifier when the service(s) provided are unrelated to the patient's terminal condition.
What is reference lab billing?
“Reference laboratory” - A Medicare-enrolled laboratory that receives a specimen from another, referring laboratory for testing and that actually performs the test. “Billing laboratory” - The laboratory that submits a bill or claim to Medicare. “Service” - A clinical diagnostic laboratory test.
What place of service should an independent or reference laboratory report when billing?
A: When billing, the place of service reported should be the location where the specimen was obtained, For example, a specimen removed from a hospitalized patient and sent to the laboratory would be reported with (POS) 21 or 22; a sample taken at a physician's office and referred to the laboratory would be reported ...
Is GW modifier only for Medicare?
There are few modifiers which are to be used only when the patient is enrolled in a Medicare certified Hospice. These modifiers play an important role in the payment process or medical billing/claims. Use of modifier GV or GW is only for the hospice patients.
What is the difference between a clinical lab and a reference lab?
Medicare defines a referred clinical diagnostic laboratory service/test as a service performed by one laboratory at the request of another laboratory. “Referring laboratory” is defined as the laboratory that refers a specimen to another laboratory for testing.
Is Quest a reference lab?
Revenues at Quest Diagnostics of Teterboro, N.J., the country's largest reference laboratory, climbed 6 percent in 2001 from a year earlier and totaled $3.6 billion.
What is place of service 11 in medical billing?
OfficeDatabase (updated September 2021)Place of Service Code(s)Place of Service Name09Prison/ Correctional Facility10Telehealth Provided in Patient's Home11Office12Home54 more rows
What services are provided in laboratories?
They perform limited diagnostic testing, reference testing, and disease surveillance. They also provide emergency response support, perform applied research, and provide training for laboratory personnel.
What is place of service code 49?
49 Independent Clinic A location, not part of a hospital and not described by any other Place of Service code, that is organized and operated to provide preventive, diagnostic, therapeutic, rehabilitative, or palliative services to outpatients only.
How do you bill a patient in hospice?
Only an attending clinician who is not employed by the hospice can bill Medicare Part B for hospice care using the CPT E/M code. If the hospice physician serves as the attending physician, all services related to the terminal condition are billed to Medicare by the hospice, not directly by the physician.
What is a 95 modifier?
95 Modifier Description The 95 modifier is defined as “synchronous telemedicine service rendered via a real-time audio and video telecommunications system.” In other words, this is a way to describe a Telehealth session. Historically, Telehealth coverage varies significantly by insurer.
What does modifier GQ mean?
Via an asynchronous telecommunications systemWhat is GQ Modifier? GQ is an option for certain situations where asynchronous telemedicine would be appropriate. Per the AMA, GQ means, “Via an asynchronous telecommunications system.” Asynchronous telemedicine means that medical care was provided via image and video that was not provided in real-time.
What is hospice billing?
To understand physician billing for hospice patients, first understand that hospice, unlike any other Medicare process, is a patient-based benefit. When a patient selects hospice, all the choices are based upon patient-centered care and preferences. Upon referral to hospice, the patient elects to cease curative treatment for the terminal diagnosis.
What is an attending physician in hospice?
The hospice attending physician is an MD, DO, PA or NP who may or may not be an employee of the hospice. An interdisciplinary hospice team includes a physician who oversees elements of the patient’s care.
What is non-attending hospice?
Non-Attending (Consulting) Physician Services. In cases where the patient requires services related to the terminal condition by a physician who is not the attending physician, this specialty physician must have a contractual agreement with the hospice for their services.
What is the life expectancy of a patient in hospice?
The attending physician and the hospice medical director or team physician must certify that the patient has a "medical prognosis that his or her life expectancy is six months or less , if the illness runs its normal course.".
Can hospice patients be billed to Medicare?
If the selected clinician agrees to be the hospice patient’s attending clinician, any focused treatment related to the patient’s terminal status that this clinician provides can be billed to Medicare directly. Only an attending clinician who is not employed by the hospice can bill Medicare Part B for hospice care using the CPT E/M code.
Is hospice a Medicare Part B or Part A?
Payments toward any treatment or care services related to the patient’s terminal illness and provided by a specialist contracted with the hospice are the responsibility of the hospice, and not Medicare Part B or Part A.
Primary Attending Physician
The primary (attending) physician is chosen by the patient and listed as the hospice attending physician on the Medicare claim form.
Consulting (or Secondary) Physician
If you are not the physician designated as the hospice primary (attending) physician on the Medicare Election of Benefits, you are considered a consulting (secondary) physician for billing purposes.
What is hospice billing?
The hospice bills Medicare with revenue codes that describe the type of care that is being provided, such as routine health care, continuous home care, inpatient respite care, or general inpatient care. There are some other services that hospice organization may bill as well.
Can a patient be discharged from hospice?
A patient may be discharged from hospice if they move from one area to another and transfer to a new hospice, the hospice determines that the beneficiary is no longer terminally ill, or the hospice determines the beneficiary meets their policy regarding discharge for cause.
Does Medicare pay for hospice care?
Medicare beneficiaries who have a terminal illness with a life expectancy of six months or less can elect to have their end-of-life care provided by a hospice organization. Medicare then pays hospice to provide all of the care that the patient needs that is related to their terminal illness.
Can hospice patients waive Medicare Part B?
According to Medicare, when the patient chooses to enter hospice they waive their rights to Medicare Part B payments for other services that are related to the treatment or management of their terminal illness , with the exception of care provided by their own attending physician. That is, benefits that would be paid by Part B for physician services ...
What is the bill code for hospice?
The hospice enters one of the following Type of Bill codes:#N#081x – Hospice (non-hospital based)#N#082x – Hospice (hospital based)#N#The fourth digit, designated with the “x” above, reflects the “frequency definition” and is designated as one of the following:
How long does it take for hospice to bill?
Time Care Coordination Carefully. Medicare allows hospice providers to bill claims within one year of the start date of service on a claim. Hospices are bound by Medicare’s rule of sequential billing, meaning claims must be filed monthly and must be filed in date order.
What is the HCPCS level 2 code for hospice?
Hospices must report a HCPCS Level II code with a level of care revenue code (651, 652, 655, and 6 56) to identify the service location where that level of care was provided. The following HCPCS level II codes report the type of service location for hospice services:#N#Q5001 Hospice or home health care provided in patient’s home/residence#N#Q5002 Hospice or home health care provided in assisted living facility#N#Q5003 Hospice care provided in nursing long term care facility (LTC) or non-skilled nursing facility (NF)#N#Q5004 Hospice care provided in skilled nursing facility (SNF)#N#Q5005 Hospice care provided in inpatient hospital#N#Q5006 Hospice care provided in inpatient hospice facility#N#Q5007 Hospice care provided in long term care facility#N#Q5008 Hospice care provided in inpatient psychiatric facility#N#Q5009 Hospice or home health care provided in place not otherwise specified (NOS)#N#Q5010 Hospice home care provided in a hospice facility#N#If care is rendered at multiple locations, identify each location on the claim with a corresponding HCPCS Level II code. For example, routine home care may be provided for a portion of the billing period in the patient’s residence, and another portion may be billed for time in an assisted living facility. In this case, report one revenue code 651 with HCPCS Level II code Q5001 and the number of days the routine home care was provided in the residence; and another revenue code 651 with HCPCS Level II code Q5002 and the number of days the routine home care was provided in the assisted living facility.
How long does it take for hospice to accept a NOE?
Providers have a maximum of five days to submit the NOE to (and receive acceptance from) their Medicare Administrative Contractor (MAC). “Provider liable days” apply when the hospice fails to file the NOE within five days. The hospice is responsible for providing all care and services to the patient as detailed in the plan ...
How long does it take to submit NOE to Medicare?
Providers have a maximum of five days to submit the NOE to (and receive acceptance from) ...
What is level of care 656?
Level of care 656: General inpatient care – Payment at the inpatient rate is made when general inpatient care is provided at a Medicare certified hospice facility, hospital, or SNF. When the patient is discharged deceased, the inpatient rate (general or respite) is paid for the discharge date.
What is hospice care?
Hospice care is end-of-life care for more than 1.65 million U.S. citizens every year—and that number is growing. Hospice involves an interdisciplinary team of healthcare professionals and trained volunteers who address symptom control, pain management, and emotional and spiritual support expressly tailored to the patient’s needs and wishes. The focus is caring, not curing. It is the model of high-quality, compassionate care that helps patients and families live as fully as possible.#N#I have had three relatives under hospice care. My personal experiences — along with five years’ working in hospice coding and billing — have corrected some misconceptions I used to have about hospice. For example, hospice is not “giving up,” nor is it a form of euthanasia or physician-assisted suicide. A Gallup poll reveals that 88 percent of adults would prefer to die in their homes, free of pain, surrounded by family and loved ones.#N#Hospice works to make this happen. For example, National Hospice and Palliative Care Organization research shows that 94 percent of families who had a loved one cared for by hospice rated the care as very good to excellent. The U.S. Department of Health and Human Services has indicated that expanding the reach of hospice care holds enormous potential benefits for those nearing end of life, whether they are in nursing homes, their own homes, or in hospitals.#N#Another important misconception is that hospice care is limited to six months of service. The Medicare Hospice Benefit does require that a terminally-ill patient have a prognosis of six months or less, but there is not a six-month limit to hospice care services.#N#Hospice eligibility requirements should not be confused with length of service. A patient in the final phase of life may receive hospice care for as long as necessary when a physician certifies that the patient continues to meet eligibility requirements. Under the Medicare Hospice Benefit, two 90-day periods of care (a total of six months) are followed by an unlimited number of 60-day periods.#N#Visit NHPCO’s Caring Connections at www.caringinfo.org for additional information about hospice and palliative care, advance care planning, caregiving, and more. The National Hospice and Palliative Care Organization also has many resources on their website at nhpco.org. Click on the resources tab to find answers to your questions.
What is hospice election?
Hospice Election. The patient can elect to use their hospice benefit when a physician certifies they have a terminal illness. The patient would have a life expectancy of six months or less if the illness runs its normal course. The hospice agency must submit a Notice of Election (NOE) to Medicare.
When can I revoke hospice benefits?
A patient may revoke their hospice benefit in the middle of the month. Submit charges to Medicare FFS (under all hospice instructions) until the first day of the following month. All claims after the first of the month go to the elected Medicare Advantage plan.
What is Medicare FFS?
Once a Medicare Advantage patient elects hospice coverage, Medicare Fee-For-Service (FFS) (i.e. Original Medicare) becomes the payer. This applies to all services provided to the patient under the normal hospice processing instructions.
Does Medicare deny services?
Medicare will deny related services. The denied services could be patient liability. Services provided by the patient-designated attending physician, nurse practitioner, or physician assistant, (if one has been designated) and. Services unrelated to the terminal condition.
Is an attending physician considered a hospice employee?
The attending physician is not a hospice employee. Payment to the attending physician is not under agreement by the patient's hospice agency. If payment is under arrangement, then the hospice agency includes the attending physician's services in its Medicare Part A bill.
Can a patient elect hospice?
A patient may elect hospice coverage. Upon election, the patient waives their right to payment for professional services for management of the terminal illness. The exception is for the professional services of an attending physician chosen by the patient who is not an employee of the hospice.
Can Medicare pay for hospice?
Medicare Payment during Hospice Election. Once the patient elects the hospice benefit, Medicare can allow: Services provided by a Medicare certified hospice agency. Services related to the terminal condition made under arrangement/contract with the hospice: Related services are part of the hospice claim to Medicare.
Is a NP a volunteer?
NP is not employed, contracted or a volunteer of the hospice (independent attending physician) - these services can be billed by the independent NP, who is the patient's attending physician, to the Part B Carrier/MAC.
Can hospices bill separately?
Medicare allows for hospices to bill separately for physician's services in the following situations: The services are professional, hands-on care. The information below identifies the type of service provided by the physician, and whether the service is separately billable to Medicare by the hospice agency. The data elements to bill physician and ...
What is the HCPCS code for hospice?
Hospices must report a HCPCS code along with each level of care revenue code (651, 652, 655 and 656) to identify the type of service location where that level of care was provided.
What is the notr for hospice?
Hospices may submit an NOTR that corrects a revocation date previously submitted in error. In this case, the hospice reports the correct revocation date in the Through Date field and reports the original, incorrect revocation date using occurrence code 56. Medicare systems use the original, incorrect date to find the election record to be corrected, then replaces that revocation date with the corrected information.
How long does a hospice patient live?
The hospice enters the NPI and name of the hospice physician responsible for certifying that the patient is terminally ill, with a life expectancy of 6 months or less if the disease runs its normal course. Note: Both the attending physician and other physician fields should be completed unless the patient’s designated attending physician is the same as the physician certifying the terminal illness. When the attending physician is also the physician certifying the terminal illness, only the attending physician is required to be reported.
What is the Medicare election period?
Medicare systems refer to the 90-day or 60-day periods as ‘benefit periods.’ Therefore, hospices should be aware that when they see references to ‘election periods’ in regulation or in the Medicare Benefit Policy Manual, they are referring to what is called a ‘benefit period’ for purposes of claims processing.
When did hospice enter NPI?
For notice of elections effective prior to January 1, 2010, the hospice enters the National Provider Identifier (NPI) and name of the physician currently responsible for certifying the terminal illness, and signing the individual’s plan of care for medical care and treatment.
When did Medicare start paying hospice services?
(Rev. 3577, Issued: 08-05-16; Effective: 01-01-17; Implementation: 01-03-17) Effective January 1 , 2005, Medicare allows payment to a hospice for specified hospice pre-election evaluation and counseling services when furnished by a physician who is either the medical director of or employee of the hospice.
Is hospice home care paid?
Routine Home Care - The hospice is paid the routine home care rate for each day the patient is under the care of the hospice and not receiving one of the other categories of hospice care. This rate is paid without regard to the volume or intensity of routine home care services provided on any given day, and is also paid when the patient is receiving outpatient hospital care for a condition unrelated to the terminal condition.