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Reimbursement Instructions - Billing Information
Revised August 2005
Reimbursement Instructions for Attending Physicians, Consulting Physicians, and Hospitals for the billing of services to hospice patients
Attending Physicians
(Office, Home, Hospital, and Nursing Home Visits/Treatments by an Attending Physician)
Use Billing Form HCFA 1500 Box 24D
If you are the Attending Physician you may bill Medicare Part B for your services.
Related Visits
If you are not a hospice employee and provide Visits or Treatments Related to a Hospice Patient's Terminal Condition, the new language for box 19 is "Attending physician not employed or paid under agreement by the patient's hospice provider." Also place a "GV" modifier in Box 24D (on the right side).
If someone in your call rotation (a Physician with whom you have a reciprocal billing arrangement and who is not a hospice employee) provides Visits or Treatments Related to a Hospice Patient's Terminal Condition, place a "Q5" modifier in Box 24D in addition to the "GV" modifier.
Unrelated Visits
If you are not a hospice employee and provide Visits or Treatments that is NOT Related to a Hospice Patient's Terminal Condition, the Box 19 language should state: "Service not related to the hospice patient's terminal condition. Place a "GW" modifier in Box 24D.
Care Plan Oversight
Attending Physicians may bill once per month fpr Care Plan Oversight. Documentation must be kept by the physician. HCFA Form 1500 CPT Code is G0182. Box 23 must include Hospice of New Jersey Provider Number: 311540
EMC Claims
Prepare claims same as above.
Consulting Physicians
Consulting Physicians must have a contractual agreement with the Hospice. Medicare Certified Hospices can only reimburse those Consulting Physicians who have a contractual relationship with the hospice. Consulting Physicians who are paid by the hospice must accept the hospice payment as "payment in full." Claims from Consulting Physicians servicing hospice patients who do not have a written Contractual Agreement with the hospice prior to provision of services will be rejected for payment.
Hospitals
Hospitals may bill for services to a hospice patient when treatments are UNRELATED to the Hospice Diagnosis/Terminal Illness. Use UB92 Box 24 condition code 07. Box 84 must contain the statement "Treatment of Non-Terminal Condition for Hospice Patient."
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