Ind. IHCP Hospice Services Provider Reference Module, Section 6, Outpatient Physician Services for Nonterminal Conditions

If an IHCP hospice member requires outpatient physician services for conditions unrelated to the terminal

condition, the member may obtain services from an IHCP-enrolled physician. The physician must obtain

PA for services that are subject to PA.

The physician should then bill Medicaid directly for those independent physician services using a

CMS-1500 claim form or electronic equivalent (IHCP Portal professional claim or 837P transaction).

A hospice provider’s coordination responsibilities for treatment of a nonterminal condition are case -

specific; however, the following guidelines should provide direction for hospice providers. If a hospice

member has no physician to treat a nonterminal condition, the hospice provider should make arrangements

to find a physician to treat the nonterminal condition. To ensure that the hospice member is not billed for

those services, the hospice provider should make sure that the physician is enrolled as an IHC P provider.

Furthermore, the hospice provider’s coordination responsibilities include advising the physician that an

individual is an IHCP hospice member to ensure that any treatment for a nonterminal condition does not

compromise a member’s hospice care.