Del. Medical Assistance Program Hospice Provider Specific Policy Manual § 4.1

4.1.1 The hospice must bill for physician services rendered to a hospice patient for a

diagnosis related to the terminal illness in two circumstances:

4.1.1.1 Circumstance 1: When a physician employee of the hospice is performing

services as an attending physician.

4.1.1.2 Circumstance 2: When the attending physician requests medically necessary

services be provided by another doctor.

4.1.2 When billing the DMAP for these physician services, the hospice must use the

procedure code that reflects what the physician would have billed the DMAP had

(s)he been able to bill directly. For each claim line enter the procedure code with

the appropriate revenue code and corresponding date of service. In addition, the

following documentation must be attached to the 837 Institutional claims as

approved by the HIPAA claims attachment requirements.

4.1.2.1 Notes written by the physician at the time that the service was rendered that

clearly documents the service given.

4.1.2.2 For Circumstance 1, a statement by hospice personnel that clearly establishes

that the hospice physician employee is performing services as attending

physician rather than acting in an administrative capacity for hospice.

4.1.3 When a physician is acting in an administrative capacity for hospice, the DMAP

cannot be billed by anyone for these physician services.