Center to Advance Palliative Care

I suspect the central issues is this: your hospice bills for you under Part A of Medicare—which is how physicians related to the hospice bill for their direct patient services when the patient has elected the Hospice Medicare Benefit. The hospice also gets its per diem payment from Medicare from Part A. Medicaid follows the same pattern. To bill outside of this, the hospice must do things differently—and that is frequently the rub—many people, including those who work in billing—resist developing new skills. Yet, many, MANY hospice agencies have done it. The hospice acquires a Part B billing number. This is not hard—but because it is ‘different’, many hospice programs say what yours says. I would counter that this is easy to do, it’s in the hospice’s interest to do it, many hospices do it and you can call and get help, NHPCO provides guidance to members who want to do it. NHPCO publishes a pamphlet on billing for physician services. Depending on your area, you may need to have contracts with insurers in order to collect—the upside is their fee schedules are often much better than that for Medicare or Medicaid. In return for the extra work, many hospices keep a percentage (5-20%) of the collected fees to cover their overhead of doing the billing for you.

Note: This response was provide with consultation from Charles F. von Gunten, MD, PhD

David E. Weissman, MD
Professor & Director of Palliative Care
Medical College of Wisconsin/Froedtert Hospital
Palliative Care Leadership Centers