Iowa Medicaid Hospice Provider Manual ch. III § D.5.c

Physician services furnished on a volunteer basis are excluded from

Medicaid reimbursement. A physician may volunteer to provide specific

services and seek reimbursement for some other services. The hospice

must have a liability to reimburse the physician for services provided

before reimbursement is claimed.

In determining which services are furnished on a volunteer basis and

which services are not, a physician must treat Medicaid members on the

same basis as other patients in the hospice. For instance, a physician

may not designate all physician services rendered to non-Medicaid

patients as volunteered and at the same time seek payment from the

hospice for all physician services rendered to Medicaid members.

EXAMPLE:

Dr. Jones has an agreement with a hospice to serve as its medical

director on a volunteer basis. Mrs. Smith, a Medicaid member, enters

this hospice and designates Dr. Jones as her attending physician. Dr.

Jones, who does not furnish direct member care services on a

volunteer basis, renders a direct member care service to Mrs. Smith.

Dr. Jones seeks reimbursement from the hospice for this service. The

hospice is paid by Medicaid at the usual payment rate for the specific

services Dr. Jones rendered to Mrs. Smith. The hospice then

reimburses Dr. Jones for this service. Dr. Jones, by virtue of his

volunteer activities, is deemed to be an employee of the hospice.