Medicare Hospice Benefit

The Medicare Hospice Benefit stipulates that we have contracts with physicians who provide services to hospice patients. Physicians often fall into both of the following contract categories for a variety of patients.

Attending Physician:

  • Refers and attends to the patient on hospice services
  • Verbally certifies prognosis of six months or less should the disease run its expected course
  • Signs and returns the initial plan of care within 48 hours of admission to initiate case management and ensure prompt payment
  • Bill Medicare Part B with GV modifier for administrative services pertaining to the hospice diagnosis
  • Bill Medicare Part B for care plan oversight using CPT code 99377
  • Procedures designated by the appropriate CPT-4 code are billed directly to Medicare Part B
  • Designate an alternate physician when you are unavailable

Consulting Physician:

  • All physicians other than the attending physicians
  • Services related to the hospice diagnosis are billed to LCFH on form HCFA 1500. Services are reimbursed at 100% Medicare allowable
  • Services unrelated to the terminal illness can be billed directly to Medicare Part B with modifier GW
  • One contract may be used for a group of physicians as long as they are listed on attachment A of contract agreement

We are not your typical hospice agency. The philosophy of our care is centered around patient and family goals. Palliative therapies recommended to alleviate symptoms or improve quality of life are encouraged and may include:

  • Thoracentesis/paracentesis to be done in the ER or radiology department
  • Blood transfusions or products such as Procrit
  • Chemotherapy and radiation therapy for pain/symptom management
  • PT/OT/ST evaluations and treatment
  • Lab/diagnostic studies and medications outside of our medication list

All therapies are evaluated for appropriateness based on the evidence of efficacy, burdens verses benefit and informed consent of the patient. That is why we request that you inform Lower Cape Fear Hospice when referring patients to other physicians or facilities as this may affect the overall plan of care and administration of the Medicare Hospice Benefit.

Our physician staff members specialize in symptom management and are available to you for consultation, 24/7. Together they work with the team of caregivers to be vigilant of changes so your patient’s needs are addressed quickly. One way this is accomplished is after a nursing assessment and likely symptoms are expected, you, the physician may be suggested to order a comfort kit. This contains medications for immediate symptom management of:

  • Pain and dyspnea due to COPD/Cancer or CHF
  • Anxiety, agitation or restlessness
  • Nausea, vomiting or excessive secretions

Having these medicines readily available to the patient has prevented many early morning calls to your office and unnecessary trips to the ER for symptom management.

If you have questions, please call us at 800.207.6908. We look forward to serving you and your patients.