Health Care Practitioner Billing Guidelines for Patients Enrolled in Hospice

Whenever a physician/nurse practitioner provides care to a patient enrolled in United Hospice of Rockland, he/ she is able to receive reimbursement for the services provided.  If the patient is covered by private insurance or Medicaid, the health care provider should bill for services as he/she would normally do.  If the patient is covered by Medicare, the Federal government has established some billing guidelines which we are happy to provide below:

Attending Physician or Nurse Practitioner Services 

When a Medicare beneficiary elects their hospice benefit, they are required to designate an Attending Physician or Nurse Practitioner.  A hospice patient can have only one Attending Health Care Professional at a time.  However, the patient has the right to change their designation at any time. 

Hospice Related Health Care Practitioner Services 

Professional services rendered by the Attending Health Care Practitioner for the treatment and management of a hospice patient’s terminal illness are billed directly by you to your Medicare Part B Contractor.  The Attending Health Care Practitioner codes the bill using a GV modifier.  The GV modifier informs Medicare that the services provided are by the Attending Health Care Practitioner who is not an employee of the hospice and is treating the patient for services related to the terminal diagnosis.  The Medicare Part B contractor pays the Health Care Practitioner based on the payment and deductible that are applicable. 

Non-Hospice Related Health Care Practitioner Services 

Services not related to the patient’s terminal diagnosis should be billed to the carrier using the GW modifier.  This modifier informs Medicare that the service is not related to the patient’s terminal diagnosis.  

Covering Physician 

In the event of an Attending Health Care Practitioner’s absence and there is a covering health care provider, the Attending Health Care Provider bills for the services of the substituting provider under the reciprocal or locum tenens billing instructions.  The Attending Health Care Provider uses the GV (related service) or GW (not related) modifier in conjunction with the Q5 or Q6 modifier. 

Contractual Agreement with United Hospice of Rockland, Inc. (UHR) 

Medicare guidelines require UHR to have a written letter of agreement with consulting physicians providing services to hospice patients in order for the physician to be paid by UHR.  If a physician does not have a written letter of agreement with UHR, please contact our Director of Finance at 845-634-4974. We will be happy to send one to you for your review and execution. 

Consulting Physician 

Consulting physicians are required to obtain a referral from the UHR Medical Director or the Attending Health Care Practitioner to provide services to a hospice patient.  Any Consulting Physician who is providing services related to the hospice diagnosis as part of the plan of care should submit Medicare charges to UHR.  UHR will bill Medicare.  The Consulting Physician will be paid by UHR at the rate of 100% of Medicare’s approved charges.  The Consulting Physician is prohibited from billing the patient or any other insurance for a balance.  The treatment plan and/or written evaluation of the Consulting Physician must be submitted with the bill to UHR. 

Care Plan Oversight 

The Attending Health Care Practitioner may bill Medicare Part B for care plan oversight.  Please contact your Medicare Part B carrier for instructions.  The Medicare contractor pays the Attending Health Care Practitioner based on the payment and deductible rules that apply.