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CAPC Palliative Care Discussion Forum
Billing and Finance
Hospice billing part A for consultantsAuthor: yaegerj
Date: Oct 24, 2010 2:33 pm
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The CMS document: "Physician Billing Grid" is a good resource (see CAPC website: Tools for Hospital-Hospice Relationships - under Hospice and Palliative Care Financing Considerations). The CMS requirements are presented in a helpful grid format. The document details under what circumstances hospices bill directly for physician services (Part A) and under what circumstances physicians bill Medicare Part B directly for services rendered to hospice patients.
Also on the CAPC website under Tools for Hospital-Hospice Relationships (url: http://www.capc.org/tools-for-palliative-care-programs/tools-for-hospice-hospital-relationships/) is a document entitled: Billing Information for Primary Physicians of Hospice patients. The use of HCFA form 1500 accompanied by the appropriate CPT code is discussed. The modifier codes addressing services related and unrelated to the terminal illness are identified:
1) GV modifier - if the primary care physician's services ARE RELATED to the patient's terminal condition;
2) GW modifier - if the primary care physician's services ARE NOT RELATED to the terminal condition;
3) Q5 modifier - if the covering physician IS A MEMBER of the primary physician's practice with GV or GW modifier as above
4) Q6 modifier - if the covering physician is NOT A MEMBER of the primary doctor's practice with GV or GW modifier as above.