Patients who sign up with hospice waive their rights to receive Medicare Part B services, and must look to the hospice organization to provide care related to the terminal illness.  The hospice provider receives a daily payment to care for the patient on hospice.  The patient’s own attending physician, (who is not an employee of hospice) designated at the time the patient signs up for hospice, may treat the patient.  

Any physician who is connected to the hospice may not bill Medicare Part B separately for the services, because the hospice is receiving a daily payment amount for the care.  The medical director of hospice may not bill Part B for any services provided to patients on hospice.  

Covered separately by Part B, is payment to a non-hospice physician, whom the patient designates at the time of hospice election, as their own physician, or in Medicare's words, the physician who "Is identified by the individual, at the time he/she elects hospice coverage, as having the most significant role in the determination and delivery of their medical care."  This physician may bill the patient for the treatment and management of terminal and non-related services.  

For the purpose of the hospice benefit, an attending physician means a professional who:

•    Is a doctor of medicine or osteopathy or

•    A nurse practitioner (for professional services related to the terminal illness that are furnished on or after December 8, 2003); and

•    Is identified by the individual, at the time he/she elects hospice coverage, as having the most significant role in the determination and delivery of their medical care.

The attending physician, that is, the patient’s own physician who is designated by the patient at the time of hospice election, uses a GV  or GW modifier on their claims. GV is defined as: “Attending physician not employed or paid under agreement by the patient’s hospice provider.”  GW is used to indicate that the service provided by the attending physician was not related to their terminal condition.

What about other physicians who may see the patient while they are on hospice?  According to the Medicare manual, Where the service is considered a hospice service (i.e., a service related to the hospice patient’s terminal illness that was furnished by someone other than the designated “attending physician” [or a physician substituting for the attending physician]) the physician or other provider must look to the hospice for payment.

Services provided by the patient’s own physician or Nurse Practitioner must be coordinated with the hospice physician.  If the patient’s own physician or NP is not available, a covering physician or NP or a covering locum may bill for the service, using the GV or GW modifier, in conjunction with the Q5 modifier for covering physicians or NPs or Q6 modifier for a locum physician.   (Billing under the locum tenens provisions is only allowed for physicians.)  Physician Assistants may not be the attending physician for hospice patients.