Reimbursement for Services

As a non-profit agency, Hospice of the Western Reserve provides palliative end-of-life care, caregiver support and bereavement services to patients and families throughout Northern Ohio, regardless of ability to pay.

Medicare

Hospice care is a covered benefit for all Medicare beneficiaries. Coverage includes the services of the hospice team, medical supplies and prescriptions for pain management and comfort care relating to the patient’s terminal illness. Standard Medicare benefits also continue for medical treatments unrelated to the terminal illness.

Physician Billing for Hospice Care

Here are some general parameters for Medicare hospice billing:

• Physicians utilize modifier GV for services related to the hospice diagnosis.
• Physicians utilize modifier GW for services unrelated to the hospice diagnosis.

Physician Billing for Care Plan Oversight (CPO)

• Physicians are entitled to bill Medicare for CPO requiring more than 30 minutes per month.
• Physicians bill the Part B carrier using CPT code G0182
• In order to be eligible, physicians must have a face-to-face encounter with the patient in the six months prior to the CPO being billed.
• There is a limit of one bill per patient, per month.
• In most circumstances, CPO billing does not apply for physicians working in Long Term Care facilities.
• This code allows for physician communications to the healthcare professionals involved in the patient care, which includes paperwork or phone calls.

For more information, please visit the National Hospice and Palliative Care Organization.

Hospital and Facility Billing for Hospice Care

Hospice of the Western Reserve’s Professional Relations team collaborates with hospitals, nursing homes, assisted living and other residential care settings to establish billing agreements. To arrange a contract or for more information, contact our Professional Relations team at 800.707.8922.

Private Insurance

Most insurance policies provide coverage for hospice care, using Medicare’s guidelines. Patients should refer to their policy for coverage and eligibility or call 800.707.8922 for additional information.