decisionhealth Newsletters, Answer Books - 2006 Issue 7 (July)
Medicare_Claims_Processing_Manual / Chapter_11 / 40.1.3
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Article Overview
This article covers Medicare hospice billing guidance for attending physician services under Chapter 11 of the Medicare Claims Processing Manual. It explains the role of an attending physician in the hospice setting, how professional services are treated when hospice coverage is elected, how carriers and hospices coordinate payment responsibilities, and how claims are reviewed when hospice benefits are revoked or when coverage information is validated. The section is relevant to billing staff, physicians, nurse practitioners, hospices, and Medicare claims processors who need to understand the general framework for processing these services.
Why This Topic Matters
Hospice elections change which professional services are paid by Medicare and which are handled through the hospice, so accurate identification of the service relationship and billing pathway is important for claims processing and payment integrity.
Article Sections
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Attending Physician Services
Overview of Medicare hospice policy for attending physician services and the relationship between hospice coverage and professional services. The section discusses how claims are coordinated across carriers, hospices, and coverage validation processes.
What You Will Learn
- How Medicare hospice coverage affects attending physician services
- How the attending physician role is identified in the hospice context
- How carrier and hospice billing responsibilities are generally divided
- How claim handling changes when hospice benefits are revoked
- How coverage information is used in hospice-related claims review
Who Should Read This
- Medical coders
- Billing specialists
- Hospice administrators
- Physicians
- Nurse practitioners
- Medicare claims processors
Modifiers Discussed
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