MHCP Provider Manual, Hospice Services, Physician Services

The rendering provider may bill primary care and attending physician’s services that are not related to the diagnosis of the terminal illness separately, as long as the primary care or attending physician is not an employee of or under contract with the hospice organization. Review the billing information in the Physicians and Professional Service section of the MHCP Provider Manual for additional information.

MHCP follows CPT guidelines for office, outpatient and inpatient services and consultations. Bill MHCP for services provided to an MA-only member. For dual eligible members, bill Part B Medicare; the claim will cross over for MA payment of copays and deductibles.

The following apply for physician services:

• When submitting claims for adult hospice services, use the appropriate diagnosis code that identifies the reason for the treatment, service or item, not the diagnosis code for the terminal illness.

• Do not submit denied Medicare physician claims to MHCP that are related to the terminal illness.

• Denied Medicare claims for physician services that are not related to the terminal illness must have an attachment stating the services billed are not related to the terminal illness, and on the claim report the reasons Medicare denied the services.