Medicare Compliance & Reimbursement

Question: Medicare recently denied a service that our physician provided to a patient in hospice care. Can we bill the hospice for the services our doctor provided, or should we try the insurance payer to pay for the services rendered?

Ohio Subscriber

Answer: The hospice is not liable to pay for the services the physician rendered unless your practice and the hospice had a prior arrangement spelling that out.

In the absence of such an agreement, you should examine what went wrong with your claim and try to resubmit it to make the claim more accurate. If the physician is not employed by the hospice or paid by it, you may need to append modifier GV (Attending physician not employed or paid under arrangement by the patient’s hospice provider) to the claim to let the insurance payer know that the hospice is not reimbursing the provider in any manner for the services rendered. This will also inform the payer that the hospice is not eligible to bill for the services rendered by the physician. Coverage may exist, however, if the service involves addressing a different diagnosis than why the patient is in hospice care.

A word of advice: It’s a good idea to check with Medicare patients for hospice enrollment status prior to services. Hospices are required to file Notices of Election within five days of start of care to signal they are enrolled and that shows up in the Medicare system pretty shortly.