For Referring Physicians

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Quick Links for For Referring Physicians

Referrals/Intake: (352) 873-7415

Early referral greatly enhances the effectiveness of the Hospice team by providing ample time to address both the physical needs of the patient and the practical, emotional and spiritual needs of the entire family. Consistently we often hear the comment: “I wish we had known about hospice much sooner.”

Our clinical care coordinators and admissions team work closely with the referring physician and staff. We are also available to meet with patients and families about hospice services.

To enhance continuity of care, we encourage physicians to oversee their patient’s hospice care. The attending physician is eligible for Medicare reimbursement related to care plan oversight and bills for services as usual, develops the plan of care and approves updates, attends Hospice team meetings if desired, and may request the hospice medical director to offer professional consultation. Only the attending physician and Hospice may bill Medicare for services relating to the terminal illness. Pre-authorization is required.

Once a patient is admitted to hospice, one of the hospice medical directors, fully licensed physicians specially trained in end-of-life and pain management care, can coordinate with the referring physician as desired to determine the most effective pain and symptom management program.

Medicare Billing

When Your Patient is on Hospice:

Physicians may hesitate to refer patients for hospice care because of a misunderstanding about loss of reimbursement.

Confusion centers around three issues: 1) how to bill for services, 2) who to bill, and 3) which services qualify for reimbursement.

We realize that this can be confusing, and so we are happy to answer your questions. Please contact Accounts Receivable at 352.854-5237 or by email (

How to Bill

The Centers for Medicare & Medicaid Services (CMS), a Federal agency within the U.S. Department of Health and Human Services, administers the Medicare program. The Hospice Manual, a detailed guide to billing for hospice services, on the CMS Web site.

Who to Bill

Pre-authorization is required for any treatment, once the patient is in our service

All attending physician services must be billed directly to Medicare Part B. If billed with the same diagnosis as hospice, you must include the GV modifier. Please do not bill these services to Hospice of Marion County, as we cannot provide reimbursement.

All consulting physician services should be billed directly to Hospice of Marion County with the referring hospice physician’s name.

Hospice of Marion County can only reimburse for services that have been authorized in the patient’s Hospice Plan of Care. The Plan of Care is a comprehensive document detailing: a) all services provided for the patient and b) services authorized for the patient.

 Attending Physician Services Qualified for Reimbursement

Care Plan Oversight:
Every Hospice patient has a Plan of Care, a comprehensive but individualized plan followed by the hospice team members, as well as the family members and caregivers. Each member of the hospice team has access to this plan, which is continually updated.

The attending physician must sign off on any change that the hospice team makes to the Plan of Care. You can bill for the following with a GV modifier: :

  • All the time spent providing this oversight, including phone consultations.
  • Visits made to treat the patient’s hospice diagnosis in any setting—hospital, nursing home, or in the home—where the patient is receiving hospice care.

Care Unrelated to the Hospice Diagnosis:
If a Hospice patient asks you to treat a medical problem unrelated to the hospice diagnosis, you can still bill Medicare Part B with a GW modifier.
While the patient is receiving services under the Hospice Medicare Benefit, coverage for any services unrelated to the hospice diagnosis remains in effect: There is no loss of coverage.

Services Not Covered by the Medicare Hospice Benefit

Under the Medicare Hospice Benefit, Medicare will not pay for any curative services directed at the patient’s life-limiting illness.

Decline in Function Scales

Functional Assessment Staging (FAST) scale: Assesses the decline of patients with Alzheimer’s disease.

FAST Scale Stage Characteristics
1… normal adult No functional decline.
2… normal older adult Personal awareness of some functional decline.
3… early Alzheimer’s disease Noticeable deficits in demanding job situations.
4… mild Alzheimer’s Requires assistance in complicated tasks such as handling finances, planning parties, etc.
5… moderate Alzheimer’s Requires assistance in choosing proper attire.
6… moderately severe Alzheimer’s Requires assistance dressing, bathing, and toileting. Experiences urinary and fecal incontinence.
7… severe Alzheimer’s Speech ability declines to about a half-dozen intelligible words. Progressive loss of abilities to walk, sit up, smile, and hold head up.

Developed by NYU Medical Center’s Aging and Dementia Research Center, Barry Reisberg, MD

Karnofsky Performance Status

Description of Function Activities/Needs Index
Normal, no complaints, no evidence of disease 100%
Able to carry on normal activity, minor signs of symptoms of disease 90%
Normal activity with effort, some signs of symptoms of disease 80%
Cares for self, unable to carry on normal activity or to do active work 70%
Requires occasional assistance but is able to care for most of own needs 60%
Requires considerable assistance and frequent medical care 50%
<50% = Hospice Referral
Disabled, requires special care and assistance 40%
Severely disabled, hospitalization indicated although death not imminent 30%
Very sick, hospitalization necessary, active supportive treatment necessary 20%
Moribund, fatal processes progressing rapidly 10%
Dead 0%

The Karnofsky Performance Status Scale is one objective means of documenting a patient’s clinical decline. Most patients with a Karnofsky scale of less than 50% are eligible for hospice care.

Palliative Performance Scale

Activity & Evidence of Disease Ambulation PPS Level
Normal activity & work ; No evidence of disease Full 100%
Normal activity & work ; Some evidence of disease Full 90%
Normal activity with effort;
Some evidence of disease
Full 80%
Unable to do normal job/work; Significant disease Reduced 70%
Unable to do hobby/housework; Significant disease Reduced 60%
Unable to do any work; Extensive disease Mainly sit/lie 50%
Unable to do most activity; Extensive disease Mainly in bed 40%
Unable to do any activity; Extensive disease
Reduced oral intake
Totally bed bound 30%
Unable to do any activity; Extensive disease
Minimal oral intake
Totally bed bound 20%
Unable to do any activity; Extensive disease
Mouth Care Only
Totally bed bound 10%

This is an abbreviated version of the Palliative Performance Scale (PPSv2) version 2, modified for use in this guide only.

Copyright © 2001 Victoria Hospice Society.

Blank scaling forms are available from Hospice of Marion County Community Liaisons by calling (352) 873-7400.

Guidelines for Determining
the Top 10 Terminal Diagnoses

The guidelines below are designed to help you make determinations and speed the process both for admission and efficiency.

  1. Alzheimer’s Disease
  2. Cancer
  3. Decline in Clinical Status
  4. Heart Disease
  5. HIV
  6. Liver Disease
  7. Neurological (ALS, MS, Huntington’s, Parkinson’s)
  8. Pulmonary Disease
  9. Renal
  10. Stroke, Coma

Download Hospice Certification Form. Please sign and fax to 352.873-7445 or call 352-873-7415

Guide for Assessing Pain

Ask your patients to rate their pain, anxiety, nausea and dyspnea.

 assessing pain

Our experts on pain and symptom management can help.

Assessing Pain and Symptoms

Ask about:

  • Intensity—what number on the scale?
  • Quality—is the pain aching, burning, stabbing or sharp?
  • Onset—when did your symptoms start?
  • Duration—how long do they last?
  • Variation—do they change?
  • Expression—crying, moaning or grimacing?
  • Factors—what alleviates them? what aggravates them?
  • ADLs—how do they affect your daily routine, emotions, etc.?