Provider Billing Guidelines
Physicians and nurse practitioners who provide care to a patient enrolled in United Hospice can receive reimbursement for services provided.
If your patient is covered by private insurance or Medicaid, you should bill for services as you would do normally. If your patient is covered by Medicare, the Federal government has established some billing guidelines, which we provided below. Each patient is evaluated by our team of specialized RN’s and our Medical Director on a case by case basis to ensure the appropriate plan of care is provided.
Attending Physician or Nurse Practitioner Services
When a Medicare beneficiary elects their hospice benefit, they are required to designate an Attending Physician or Nurse Practitioner. A hospice patient can have only one Attending Health Care Practitioner at a time. The patient has the right to change their designation at any time.
Hospice Related Health Care Practitioner Services
Professional services rendered by the Attending Health Care Practitioner for the treatment and management of a hospice patient’s terminal illness are billed directly by you to your Medicare Part B Contractor. The Attending Health Care Practitioner codes the bill using a GV modifier. The GV modifier informs Medicare that the services provided are by the Attending Health Care Practitioner who is not an employee of the hospice and is treating the patient for services related to the terminal diagnosis. The Medicare Part B contractor pays the Health Care Practitioner based on the payment and deductible that are applicable.
Non-Hospice Related Health Care Practitioner Services
Services not related to the patient’s terminal diagnosis should be billed to the carrier using the GW modifier. This modifier informs Medicare that the service is not related to the patient’s terminal diagnosis.
In the event of an Attending Health Care Practitioner’s absence and there is a covering health care provider, the Attending Health Care Provider bills for the services of the substituting provider under the reciprocal or locum tenens billing instructions. The Attending Health Care Provider uses the GV (related service) or GW (not related) modifier in conjunction with the Q5 or Q6 modifier.
Contractual Agreement with United Hospice (UH)
Medicare guidelines require United Hospice to have a written letter of agreement with consulting physicians providing services to hospice patients in order for them to be paid by UH. If you do not have a written letter of agreement with UH, please contact our Director of Finance at 845-634-4974. We can send one to you to review and execute.
Consulting physicians are required to obtain a referral from the United Hospice’s Medical Director or the Attending Health Care Practitioner to provide services to a hospice patient. Any Consulting Physician who is providing services related to the hospice diagnosis as part of the plan of care should submit Medicare charges to United Hospice. United Hospice will bill Medicare. The Consulting Physician will be paid by UH at the rate of 100% of Medicare’s approved charges. The Consulting Physician is prohibited from billing the patient or any other insurance for a balance. The treatment plan and/or written evaluation of the Consulting Physician must be submitted with the bill to United Hospice.
Care Plan Oversight
The Attending Health Care Practitioner may bill Medicare Part B for care plan oversight. Please contact your Medicare Part B carrier for instructions. The Medicare contractor pays the Attending Health Care Practitioner based on the payment and deductible rules that apply.