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Payment for Physician Services Under Hospice

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 beneficiary’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. The physician serving as the medical director and the physician member of the hospice interdisciplinary group generally perform the activities. Group activities include:

  • Participation in the establishment of plans of care
  • Supervision of care and services
  • Periodic review and updating of plans of care
  • Establishment of governing policies 

Payment rates for routine home care, continuous home care, and inpatient respite care include the costs for these services.

Payment should be made to the hospice for other physician services, such as direct patient care services that hospice employees provide to individual patients and services that the hospice arranges, unless the services were provided voluntarily. The state may opt to reimburse the hospice according to the usual Medicaid payment policy for physician services or according to the Medicare methodology for payment of hospice physician services. This payment is in addition to the daily rates. Total payments made to the hospice for these services, along with total payments made at the various hospice daily rates, determine whether the state has exceeded the optional hospice cap. Note that attending physicians bill for their professional services only. Costs for services such as lab or X-rays are not included on the attending physician’s bill.