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CAPC Palliative Care Discussion Forum
Billing and Finance

Next Reply: Re:Medicare Part B for non hospice related diagnoses
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Post Medicare Part B for non hospice related diagnoses
Author: Debi
Date: Nov 19, 2008 3:28 pm
While indicating that the Medical Director has a financial, yet contractual agreement with the hospice agency, who would he/she bill under the following circumstances? A hospice patient who is also using the Med. Director as his/her attending, visits the office for symptoms non related to the hospice diagnosis. Wouldn't this OV be billed to Medicare Part B? If the patient visits the office of the attending who is also the Med Dir of the hospice agency caring for this patient, and is symptomatic of the hospice related diagnosis, then this would be billed to Medicare Part A, correct?
Replies: order by [Date] [Author] [Subject]
Re:Medicare Part B for non hospice related diagnoses (by JulieP on 11/19/2008)
The office visit that doesn't relate to the hospice diagnosis would be billed to part B; make sure you append the GW modifier to the service so that Medicare knows why you're billing them. Even if your diangosis is different than the diagnosis that has landed the patient in hospice you may be required to submit medical records to prove that. When the patient presents to the clinic for hospice related services and is treated by the medical director of the hospice agency, the claim is sent to the hospice agency who then pursues part A for payment.

Julie Pipke, CPC
Reimbursement Manager, Medicine
Medical College of Wisconsin
Milwaukee, WI
Re:Medicare Part B for non hospice related diagnoses (by AmberBJones on 11/20/2008)
The responses already provided to this question are correct. For a review of the CMS billing considerations for physicians providing hospice services, go to the CAPC homepage (www.capc.org) and enter physician billing grid in the search bar.

Amber Jones, MEd
CAPC Hospice Liaison Consultant

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