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Billing and Financial

Next Reply: Re:Palliative Medicine Consult Service
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Post Palliative Medicine Consult Service
Author: trianoml
Date: Sep 29, 2008 8:29 pm
I am an NP who works with A board certified H&PM MD. We are consulted for pain & symptom management for EOL care in an acute care hospital. Often these patients transition to a inpatient hospice. There the PCP consults us for pain & symptom management also. The Hospice medical director is an oncologist who is not a palliative medicine doc who does not see the patients (only conducts IDT weekly). We have been told by the Hospice Administrators that we can not see the patients on consult. We believe they cannot block the consult because they are not able to provide the level of care that is best for the patient. We realize we would need a contract with the hospice and bill the hospice who in turn would bill Medicare Part B? Any thoughts? The Regulatory specialist at NHPCO said "we should be able to bill and ask CAPC".
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+ Re:Palliative Medicine Consult Service (by JulieP on 10/23/2008)
This is a tough question and I had to go to the experts to get some answers. I will give you a condensed version of hospice billing in hopes that this will be helpful to you. Attending Md not employed or volunteer of hospice may bill Part B. Consulting MD no employed or volunteer of hospice must bill hospice and hospice bills Part A and reimburses the MD at 100% of Medicare allowable. Consulting MD for non-related to hospice dx may bill Part B using appropriate modifier. NP attending may bill Part B using appopriate modifier. NP consult can't bill anywhere because Part A does not have a modifier to allow it, Part B will deny it. It's possible that the hospice unit may not allow PC consults on their unit because they more than likely have a hospice MD who is seeing the patient on their unit and need to bill for them. If the PC MD came on the unit-they could not both bill for the same hospice dx although if the PC MD came on the unit for a consult for a symptom the the hospice could not control the PC MD could bill using the symptom.
Re:Palliative Medicine Consult Service (by ehargus on 10/23/2008)
This is not "just a billing question." It really boils down to an ethical question. If their hospice physician is not certified in hospice and palliative care medicine and they deny your doctor's ability to see their patient, I there is a real problem with that. I am wondering whether the hospice involved is non-profit or not (I don't need to know---just a retorical question). If one really wanted to open up a can of worms, one could ask the fiscal intermediaries opinion or even attorney general's of the state you are in. Patients need to come first---and not organiztions, even if it means a knock down drag out fight.

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