Reimbursement and Billing

Question 1

Medicare Modernization Act (2003)

Answer 1

Further defined role of NP
Recognized role of NP in palliative care. NP can serve as attending physician for these patients in hospice and outside of hospice. We cannot certify poor prognosis and the terminal illness as per Medicare Conditions of Participation or serve as hospice medical director. We can refer to hospice. NP rate is still 85% of physicians rate for reimbursement.

Question 2

Hospice NPs in the attending physician role bill what part of Medicare.

Answer 2

A.

Question 3

Nonhospice NPs serving as attending physician or palliative care consultant bill what part of Medicare.

Answer 3

B

Question 4

NP cannot

Answer 4

Certify terminal illness
Replace the medical director
Bill for services rendered while employed in a hospice unless acting as attending physician - then bill to A

Question 5

Hospice NP must:

Answer 5

Provide services that would be otherwise provided by a physician.

Question 6

Services that can be provided by hospice RN, that are done by an NP

Answer 6

Cannot be billed.