When you refer a patient with advanced illness to Hospice of Santa Cruz County and are named as their hospice attending physician, you have the option to actively support their care plan and bill for the services you provide related to their terminal condition.

As the attending physician for a Hospice of Santa Cruz County patient, you play a crucial role within our interdisciplinary team. Your knowledge of the patient is invaluable, and we collaborate closely with you to create a tailored care plan.

Hospice care through Hospice of Santa Cruz County offers significant benefits to both you and your patient:

• Consider the interdisciplinary team at Hospice of Santa Cruz County as an extension of your care within the patient’s chosen setting. Both you and your patient, along with their caregivers, gain support from our team, which addresses the patient’s physical, spiritual, and psychosocial needs.
• Our interdisciplinary teams comprise a hospice physician, nurse, hospice aide, social worker, and chaplain. This team provides comfort, dignity, and personalized care directly to wherever the patient calls home.
• Our expanded services ensure that patients receive expert symptom management and quality of life enhancements, including dietary support, music and pet visits, and massage therapy.
• We assist in both informing and implementing your patient’s care plan, respecting their goals, wishes, and values.

Hospice and palliative medicine primarily aim to manage symptoms and enhance the quality of life for patients and their families. Research indicates that early access to hospice care leads to better symptom control, goal achievement, overall care quality and often times extended prognosis.

Studies by NORC at the University of Chicago show a positive link between increased hospice use in the final six months of life and higher satisfaction and quality of life levels. Additional studies back these findings:

• Patients: Those admitted to hospice within the last six months reported higher satisfaction, better pain management, fewer hospitalizations, reduced physical and emotional distress, and overall improved quality of life.
• Families: Families of patients in hospice for over 30 days experienced better outcomes. They were more likely to see end-of-life preferences honored and rated the quality of care as excellent. Home hospice care also helped reduce the risk of prolonged grief disorder.
• Caregivers: Caregivers reported less PTSD when patients received home hospice care. These findings highlight the crucial role hospice plays in improving the well-being of patients, families, and caregivers at the end of life.

As an attending physician, nurse practitioner, or physician assistant, you are a key part of a supportive network ensuring your patients receive comprehensive, compassionate care suited to their unique needs and preferences.

Embracing hospice early in the care process not only enhances the quality of life for terminally ill patients but also provides much-needed support for families and caregivers. Additionally, you can continue to be reimbursed for your patient encounters.

Terminally ill Medicare beneficiaries eligible for Part A hospital insurance can opt for hospice benefits instead of standard Medicare coverage. This choice emphasizes comfort and quality of life over curative treatments, with two initial 90-day periods followed by unlimited 60-day periods. Beneficiaries can voluntarily end their hospice benefits if they choose to seek curative care or life-prolonging care.

When hospice coverage is elected, beneficiaries give up Medicare Part B payments for terminal illness-related services, except those provided by their attending physician or nurse practitioner. This ensures they receive comprehensive support, including medical, emotional, and spiritual care, without typical Medicare Part B costs.

Modifiers GV and GW are essential in medical billing for terminally ill patients. These modifiers help accurately document the services provided under hospice care, ensuring proper reimbursement and adherence to regulations.

• Modifier GV: This modifier is used for services provided by a physician who is not the patient’s attending physician within the hospice program. It indicates that the service was provided to a patient enrolled in hospice care by their attending physician at the time of hospice enrollment.
• Modifier GW: This modifier applies to services provided by the patient’s attending physician that are not reimbursed under the hospice arrangement. It identifies services unrelated to hospice care, ensuring billing accuracy and compliance.

In hospice billing, specific guidelines must be followed regarding the placement of the GW modifier. The HCPCS code should be listed first, immediately followed by the GW modifier on the claim form. This practice ensures proper documentation and accurate billing.

By understanding and appropriately applying these modifiers, healthcare providers can streamline the billing process, optimize reimbursement, and deliver high-quality care to patients approaching the end of life.

You can be reimbursed for care plan oversight if you:

• Provide supervision for at least 30 minutes per month AND
• Bill Medicare Part B for services to your patient AND
• Have seen the patient within 6 months prior to supervision

Review of reports, treatment plans, and/or lab results

• • Does not include the initial interpretation or review of results ordered during or associated with face-to-face patient encounter

Integration of new information into the treatment plan

Medical decision making

• • More than talking with patient/family to adjust medication or treatment

Discussions with other health professionals involved in your patient’s care

• • Phone or in-person discussions
  • But not with members of your own practice or informal consults with other health professionals not involved in patient’s care

Phone or in-person discussion with pharmacist about Pharmacological therapy

• • Does not include time calling prescriptions to pharmacy

Team conferences

• • Must document time per individual patient

Documentation in patient’s chart of services provided

• • Note services, decision-making, and amount of time spent providing services

• • Bill one time per month with at least 30 minutes of supervision