N.H. Medicaid Hospice Provider Manual, Vol. II, § 10, Payment for Physician’s Services

If a member’s attending physician, who is not an employee of the designated hospice or providing

services under arrangement with the designated hospice, provides physician services related or

unrelated to the treatment of the terminal illness:

1. These physician services shall not be considered as part of the hospice per diem rate

described above; and

2. The physician shall bill for these physician services separately, and be reimbursed at the

regular physician services rate in accordance with the provider specific Physician Billing

Manual, Volume II.

If a member’s attending physician, who is not an employee of the designated hospice or providing

services under arrangement with the designated hospice, requests through an order that the medical

director or hospice physician provide physician services, these physician services may be billed in the

same manner described above, except that the following services may not be billed:

•

general supervisory services of the medical director;

•

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 by the

physician member of the interdisciplinary group; and

•

physician services that are related to the treatment of the terminal illness.

If a member does not have an attending physician at the time of electing the hospice benefit, the

medical director of the designated hospice provider or the physician member of the hospice

interdisciplinary group shall be the member’s attending physician, and bill and receive payment as

follows:

1. Physician services that are related to the treatment of the terminal illness shall be considered

hospice services, and be included in the hospice per diem rate described above under

“Payment Policies”; and

2. Physician services that are unrelated to treatment of the terminal illness shall be considered

physician services, and shall be billed separately by the physician and be reimbursed at the

regular physician services rate in accordance with the provider specific Physician Billing

Manual, Volume II. These services shall not be billed by the hospice provider.