Understanding Hospice Care

Reimbursement for Services

• How to Bill for Services
• Who to Bill
• Attending Physician Services Qualified for Reimbursement
• Services Not Covered by the Medicare Hospice Benefit

Occasionally, doctors may hesitate to refer patients for hospice care because they fear not being reimbursed.

Confusion centers around three issues: 1) how to bill for services, 2) who to bill, and 3) which services qualify for reimbursement.

We realize that this can be confusing, and so we are happy to answer your questions. Please contact Accounts Payable, at 702-636-0200.

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How to Bill for Services

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 a copy of The Hospice Manual, a detailed guide to billing for hospice services, on the CMS Web site (Scroll down the page until you get to Publication # 21, The Hospice Manual.)

You might also want to look at the Physician’s Information Resource for Medicare.

Who to Bill

Here are two common sources of confusion:

• All attending physician services must be billed directly to Medicare Part B. Please do not bill these services to CompassionCare Hospice, as we cannot provide reimbursement.
• All consulting physician services should be billed directly to CompassionCare Hospice, but you must use the proper consulting code to qualify for reimbursement. If the wrong code is used, we cannot reimburse.

Please note: CompassionCare 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: 1) all services provided for the patient and 2) services authorized for the patient.

Attending Physician Services Qualified for Reimbursement

Care Plan Oversight:
Every CompassionCare Hospice patient has a Plan of Care, a comprehensive but individualized plan followed by everyone—hospice team members and family members. Each member of the hospice team has access to this plan, which is continually updated.

The attending physician must sign off on any change that the hospice team makes to the Plan of Care. You can bill for:

• All the 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—where the patient is receiving hospice care

Care Unrelated to the Hospice Diagnosis:
If a CompassionCare 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

Under the Medicare Hospice Benefit, Medicare will not pay for any curative services directed at the patient’s life-limiting illness.

Although the Medicare Hospice Benefit does not cover services unrelated to the hospice diagnosis, the patient’s regular Medicare coverage remains in effect and does cover such services.