CMS Pub. 100-04, ch. 11, § 40.1.2

Under the Medicare hospice benefit, an attending physician is defined as a doctor of

medicine or osteopathy or a nurse practitioner or physician assistant (for professional

services related to the terminal illness that are furnished on or after December 8, 2003

and January 1, 2019, respectively) who is identified by the patient, at the time he/she

elects hospice coverage, as having the most significant role in the determination and

delivery of his or her medical care. Payment for physicians, nurse practitioners, or

physician assistants serving as the attending physician, who provide direct patient care

services and who are hospice employees or working under arrangement with the hospice,

is made in the following manner:

• Hospices establish a charge and bill the A/B MAC (HHH) for these services

under Medicare Part A.

• The A/B MAC (HHH) pays the hospice at the lesser of the actual charge or 100

percent of the Medicare physician fee schedule for physician services or 85

percent of the fee schedule amount for nurse practitioner or physician assistant

services. This payment is in addition to the daily hospice rates.

• Payment for attending physician services is counted with the payments made at

the daily payment rates to determine whether the overall hospice cap amount has

been exceeded.

• No payment is made for attending physician services furnished voluntarily.

However, some attending physicians may seek payment for certain services while

furnishing other services on a volunteer basis. Payment may be made for services

not furnished voluntarily if the hospice is obligated to pay the attending physician

for the services. An attending physician must treat Medicare patients on the same

basis as other patients in the hospice and may not designate all services rendered

to non-Medicare patients as volunteer and at the same time bill the hospice for

services rendered to Medicare patients.

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

director on a volunteer basis. Dr. Jones does not furnish any direct patient care

services on a volunteer basis. A Medicare beneficiary enters the hospice and

designates Dr. Jones as her attending physician. When he furnishes a direct

service to the beneficiary, he bills the hospice for this service and the hospice in

turn bills the A/B MAC (HHH) and is paid for the service. Dr. Jones may not bill

Medicare Part B as an independent attending physician because as a volunteer he

is deemed to be a hospice employee.

• No payment is made for nurse practitioner services that can be performed by a

registered nurse, nor is payment made for nurse practitioner services that are

performed outside of the attending physician role.