Oncology & Hematology Coding Alert

Question: Our doctor had a patient who was transferred to hospice and is in a nursing home. The doctor is still managing the patient care. We billed Medicare for the doctor's nursing-home visit, but Medicare refused since the patient is in hospice, Medicare will not pay the doctor. Who should pay for the doctor's visits?

Florida Subscriber

Answer: You bill the hospice for the visit because the patient is in an SNF (skilled nursing facility), and they bill for Part A. Therefore, the patient's entire stay is considered to be a Part Astay. There are a few exceptions to this, such as billing for chemotherapy; however, supportive drugs that are given because of chemotherapy must be billed to the SNF.

The final answer also depends on whether your physician is the attending or a consulting physician. Attending physicians bill Medicare, while consulting physicians bill the hospice (assuming the care is related to the terminal illness) if they have a written consulting-physician agreement with that hospice.

If your doctor is the attending physician chosen by the patient when he applied for hospice benefits, then the doctor can bill Part B using the terminal diagnosis. The oncologist must indicate on the claim (box 19) that the "physician is not employed by hospice." If the patient did not designate your doctor as his attending on the hospice application, your doctor cannot bill for his services in managing the patient's care.