MO HealthNet Hospice Provider Manual § 2.15

The basic payment rates for hospice care are designed to reimburse the hospice for the costs of all covered services related to the treatment of the participant's terminal illness, including the administrative and general supervisory activities performed by physicians who are employees of or working under arrangements made with the hospice. These activities are generally performed by the physician serving as the medical director and the physician member of the hospice interdisciplinary group. Group activities include participation in the establishment of plans of care, supervision of care and services, periodic review and updating of plans of care, and establishment of governing policies. The costs for these services are included in the reimbursement rates for routine home care, continuous home care, inpatient respite care, and general inpatient care. Refer to Section 2.12 in this manual for more information on these levels of care.

MHD reimburses the hospice for other physicians’ services, such as direct patient care services, furnished to individual participants by hospice employees, and for physician services furnished under arrangements made by the hospice unless the patient care services were furnished on a volunteer basis. Refer to the Physician Provider Manual for information on the physician's program services.

The hospice is reimbursed in accordance with the usual MHD reimbursement policy for physicians’ services. The appropriate procedure code must be entered on the Hospital Claim Form (UB-04). This reimbursement is in addition to the daily hospice rates. To simplify the billing procedures, the hospice provider may want to request that the physician complete and send to the hospice a Health Insurance Claim Form (CMS-1500) completed in accordance with MHD claim filing requirements. The hospice can then use the appropriate procedure codes and include the physician billing information on the UB-04 claim form. Providers should not attach the CMS-1500 claim to the UB-04. Refer to the Physician Provider Manual for information on completing a CMS-1500.

Physician services provided by the individual’s attending physician, who is not an employee of or receiving compensation from the hospice, for services provided for the hospice are reimbursed directly to the physician at the lesser of the billed amount or the MHD maximum allowable amount, subject to the benefits and limitations of the Physicians Program. These services must be billed directly to the fiscal agent by the attending physician on the CMS-1500 using the appropriate physician or clinic provider identifier. To be reimbursed, the physician must be a MO HealthNet participating provider on the date of service. Refer to the Physician Provider Manual for more information.

The only services to be billed by the attending physician are the physician’s personal professional services. Other services such as laboratory or x-rays cannot be billed by the attending physician or any other provider.