GENERAL GUIDELINES TO REFER A PATIENT TO HOSPICE
Ask yourself, "Would I be surprised if my patient wasn't alive next year?" Medicare guidelines require certification that a patient has life expectancy of six months or less, "if the disease runs it normal course."
- Meet with the patient and his/her family and address their concerns
- Explain our services and Medicare guidelines
- Nurse availability 24-hours a day
- Social Workers
- Schedule doctor visits
- Bereavement programs for adults and children
- Help to relieve anxiety and dispel myths during the difficult time
If you're not sure if your patient would meet the criteria, we will assess and evaluate your patients anytime and where it's convenient.
We can meet:
- In your office
- The patient's home
- In the hospital
- In a SNF or ALF
- Our office
Call us at 800.745.6132 for an "information only" visit. We are here to help you and your patients.
PHYSICIAN SERVICE BILLING FOR HOSPICE PATIENTS WITH MEDICARE
For the treatment and management of the terminal illness, the physician should bill Part B using the GV modifier. The exception to this would be if the attending physician is also employed by the hospice in which case he/she would bill the hospice provider. The hospice provider would bill Medicare and reimburse the physician at the Medicare allowable rate. If a physician is covering for the attending physician and is not employed by the hospice, he/she bills using the GV modifier in conjunction with the Q5 modifier.
For services unrelated to the terminal diagnosis, the physician bills using a GW modifier.
These are physicians, other than the attending, who have provided services approved by the hospice and related to the terminal diagnosis. The physician bills the hospice provider. The hospice provider bills Medicare and reimburses the physician the Medicare allowable rate. This requires a one time contract between the hospice and the physician which is provided by the hospice.
For Medicare Coverage Guidelines, please click here.
Questions or concerns should be addressed to our Billing Manager Penny Freeman at 443.837.1522.