decisionhealth Newsletters, Part B News - 2019 Issue 12 (December)
Only charge hospice patients for non-end-of-life issues — unless you’re the attending
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Article Overview
This article addresses a hospice billing scenario that can affect Medicare Part B claims when a patient receiving the Part A hospice benefit seeks care outside the terminal condition. It is aimed at physicians, coders, and billing staff who need to understand when to coordinate with a hospice, when claims are billed normally, and when attending-physician status changes the billing pathway. The discussion covers general hospice-related claim handling, common documentation concerns, and the broad categories of modifiers and professional-versus-technical billing considerations involved.
Why This Topic Matters
Hospice-related claims can deny if they are not clearly separated from terminal-condition care. Understanding the general billing distinctions helps practices reduce denials and submit claims appropriately when a hospice patient is seen for unrelated services or by an attending physician.
Article Sections
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Question and billing scenario
Introduces a hospice patient encounter in a non-hospice setting and frames the billing and coordination questions raised by the situation.
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General billing approach for unrelated services
Explains the broad distinction between hospice-covered care and other medically necessary services, including the role of claim handling and hospice verification.
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When care may be considered related to hospice
Discusses situations in which conditions or treatments may overlap with the hospice diagnosis or related conditions, and why that distinction matters for billing.
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Are you attending?
Describes how attending-physician status affects hospice billing responsibilities and the patient election process.
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2 additional factors to remember
Summarizes additional considerations involving scope of practice and the division of professional and technical services in the hospice setting.
What You Will Learn
- How hospice status affects billing for non-terminal-condition services
- When coordination with a hospice provider may be relevant
- How attending-physician status changes the general claim pathway
- What additional billing considerations may apply to professional and technical services
- Which organizations and Medicare concepts are commonly involved in hospice claim questions
Who Should Read This
- Physicians
- Billing staff
- Medical coders
- Practice managers
- Hospice-related administrative staff
Codes Discussed
Modifiers Discussed
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