Physician Payment Outline.

We receive many questions about hospice and its impact on the attending physician’s ongoing role and ability to bill Medicare for services they provide to the individual accessing their Medicare hospice benefit.

To assist you in navigating the hospice physician payment process, we have developed the following outline:
Ask yourself the following questions (A, B, and C) and then proceed to 1, 2, and 3.

A) Are you the attending or primary physician providing proffesional service to this Medicare patient?
B)Are the service that you provide related to the hospice diagnosis?
C)Are you providing consulting services related to the hospice diagnosis?

The following section pertains only to those indiviuals who have elected their Medicare hospice benefit,not those who are receiving palliative home care.

1) If you answered Yes to question A, but No to question B, follow these instructions:
Process the claim to the fiscal intermediary as you would ordinarily. Use modifier “GW” in Box 24D. (This modifier indicates that
the services you are providing are not related to the patient’s terminal condition.)

2) If you answered Yes to questions A and B, follow these instructions:
The physician bills Medicare using HCFA form 1500. Use modifier “GV” in Box 24D. ( This modifier indicates that the billing MD
has been designated as the attending physician for this hospice patient and is not employed, nor paid, by the hospice for these services.)

3) If you answered No to question A, but Yes to question C, follow these instructions:
Process billing and documentation of services for the hospice patient to Fidelis Hospice and Palliative Care at the contracted
amount. Fulfills Medicare hospice regulations (42 CFR 418.56),/.

  • “Our position with the individual and family is simple. I’m here for you. I will keep you company and make you as comfortable as possible as you start your journey.”

    - Sherry Martin, Vigil Volunteer

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