Referring a Patient To Hospice

Any patient who chooses comfort care over curative treatment, has a life threatening illness, and an expected prognosis of 6 months or less can be referred to hospice for
supportive care. Hospice is a specialty and has expertise in caring for patients with many
life-limiting illnesses and conditions. Any condition that is deemed terminal, qualifies for
hospice care. The patient’s physician is typically the one to make the referral and must
be the one to certify that the patient is medically appropriate for hospice care.


It is often said by patients and families that they wish they would have accepted hospice
sooner. The earlier a patient is referred, the more hospice can do to help. Early referrals
improve the quality of the patient’s life. The patient is more involved in making
decisions; this in turn helps the family know that those difficult choices they need to
make are what the family member desires. Decisions can be made prior to a moment of
crisis. Sadly, many people believe that a patient must be confined to the home or bed to
qualify for hospice care. A great deal can be done, however, many months earlier to
improve quality of life.

Levels of Care

  • Routine Home Care – The majority of hospice care is provided as routine home care
    which means in the patient’s home. The patient’s home may be their private residence,
    an assisted living facility or a long-term care facility such as a nursing home. Hospice
    patients spend more than 95 percent of their hospice experience in routine home care.
  • Continuous Care – In the event of a medical or psychosocial crisis, care is provided
    continuously in the home for brief periods of time.
  • Inpatient Respite – Caregivers occasionally need to take short breaks to maintain their
    own health and wellbeing. In this instance, the patient can be transferred to the
    Shenandoah House or to Augusta Health for a short-term stay, up to five days, while the
    caregiver takes a break.
  • General Inpatient Care (Acute Care) – When symptoms can’t be controlled in a home
    setting, the patient can be moved to the Shenandoah House or to Augusta Health for a
    short-term stay until the patient’s condition is under control.

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.

Attending Physician Services Qualified For Reimbursement

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.

Physician Reimbursement For Services

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.

If you as the physician have any questions about your reimbursement while the patient is open to hospice care, our billing team can be a resource for you. Feel free to call 540-332-4943 for assistance.

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.