My mother passed away while in hospice care.  As someone with first-hand experience, I see the definite value in the service.  After spending many years working in a Radiation Oncology practice, I feel that Hospice is often an underutilized option for many patients.  I think this is mainly due to common misconceptions about what “hospice” really means. 

When I saw an article titled Physicians Are Biggest Influencer of Hospice Enrollment posted online by Medscape, I had to read it. One statistic listed in the article that seemed obvious was “Patient load also varied by specialty, and although medical and radiation oncologists constituted only 19% of the physicians in this cohort, they cared for 57% of all patients.”

It seemed obvious since unfortunately many deaths are due to cancer.  While medical and radiation oncologists do still provide care to hospice patients, there are some guidelines to what care is covered as set forth by the hospice organization.

On more than one occasion when working in the radiation oncology practice, I found out after services were rendered that the patient was enrolled in Hospice.  It was usually by receiving a denial from Medicare.  Not that I am proclaiming myself an expert, but I did learn some helpful things and would like to pass them on to assist my medical billing friends.

In the billing office, we are seldom face to face with patients.  The nurses however see them almost every day, especially those that are the most ill.  I found it very helpful to educate the nurses on the reasons billers and doctors need to know if a patient “mentions” hospice. 

Once they have enrolled, all care needs to be discussed with their case worker.  Many times in the case of radiation, a plan of palliative care must be sent to them for review and approval. Typically a formal authorization is given that is attached to the claims.  Billing of services to their insurance company desists.

Billing Note: Payments we received were a lump sum with just a date range of the claim and no line level adjudication information.  The Claim Level Payment option available in Iridium Suite, will proportionally distribute lump sum payments and adjustments.  This eliminates the need for manual calculation by the user of the live level payment amounts. Get a free demo of this and many other valuable features today!

Helpful Hint: A radiation oncologist could see a patient for follow up care that has enrolled with hospice for another condition. In this circumstance the evaluation and management code will be submitted to the insurance with a “GW” modifier appended to the code.