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CAPC Palliative Care Discussion Forum
Billing and Finance

Next Reply: Re:consulting on inpatient Hospice patients
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Post consulting on inpatient Hospice patients
Author: DharmaDoc
Date: Mar 17, 2010 3:52 pm
Hi,
I'm the physician medical director for Palliative Medicine at our hospital. I have been consulted on a number of Hospice inpatients, particularly regarding pain management. My Billing Office now is telling me that I cannot get paid for these visits, because I billed for the same diagnosis that was entered by Hospice. I am told that the hospital was paid under Medicare Part B, and that Hospice was paid by the hospital. Should I be asking Hospice for payment?
Thank you.
Francine
Replies: order by [Date] [Author] [Subject]
Re:consulting on inpatient Hospice patients (by sreynolds on 03/18/2010)
I would like to clarify this billing situation and then let you know how you as a consutling physician can be reimbursed. 1. The hospital cannot bill Medicare for a hospice general inpatient stay. The hospital must have a contractual relationship with the hospice and they bill the hospice for the general inpatient stay. 2. The hospice bills Medicare Part A for the general inpatient level of care if the hospice patient was a Medicare beneficiary. 3. If you are seeing the patient for the same hopsice diagnosis, you need to have a contractual relationship with the hospice to provide consulting physician services (every hospice should hace this, but if they don't let me know and I will forward you one for them to sign so you can be reimbursed). Your charges are submitted to the hospice, which are then billed on their hospice claim to Medicare (if they do not know how to do this I will provide my contact info. and you can have them contact me so they can bill for your charges). Once, they are reimbursed,they should pay you. Let me know if I can be of further assistance off line by contacting me through my email sreynolds@fhpc-in.org Hope this helps. SueAnn
Re:consulting on inpatient Hospice patients (by JulieP on 04/06/2010)
When you are not the hospice attending provider and have no financial arrangement with the hospice agency you should be billing your services to Part B. In similar situations we add the GW modifier and submit to the Part B carrier. We have no idea what diagnosis was entered (used for billing?) by the Hospice carrier and we've not had problems with reimbursement. You would only request reimbursement from the hospice if you were the attending hospice provider of record and if you had a financial relationship (usually director) with them.
Julie Pipke, CPC RM @ MCW

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