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Reimbursement for Services

If you as the physician have any questions about your reimbursement while the patient is open to Hospice, Augusta Health Hospice Billing can be a resource for your office. Confusion centers around three issues:

  1. How to bill for services
  2. Who to bill
  3. Which services qualify for reimbursement

If you have any questions not covered here, please contact:

cmckay [at] augustahealth [dot] com (Cheryl McKay)
Hospice Billing
(540) 332-4943 Staunton
(540) 932-4943 Waynesboro

How to Bill for Services

Who to Bill

All attending physician services must be billed directly to Medicare Part B as you have always done. The attending physician will not be billing Hospice for these services.

All consulting physician services need to be billed directly to Augusta Health Hospice, but you must use the proper consulting code to qualify for reimbursement. If the wrong code is used, we cannot reimburse.

Please note: 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 all services provided for the patient and services authorized for the patient.

Attending Physician Services Qualified for Reimbursement

Care Plan Oversight

Every Hospice patient has a comprehensive and individualized Plan of Care. The attending physician must sign off on any change that the hospice team makes to the Plan of Care.

You can bill for:

  • 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, wherever the patient is receiving hospice care

Care Unrelated to the Hospice Diagnosis

If a 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

  • Will not pay for any curative services directed at the patient's life-limiting illness.
  • Care not related to the terminal diagnosis is not covered under the Hospice Benefit. These would be covered by the routine Medicare benefit.

Links

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 detailed guides for hospice services on the CMS web site.

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