A Clarification in New Change in Attending Physician Rules
September 29, 2014 10:58 AM
As previously reported, on October 1, 2014, hospices must begin including attending physician information on the hospice election statement and patients must file a written request for a change in attending physician with the hospice. There have been some questions about what constitutes a change in attending physician. While CMS has not defined this specifically, it does state in the comments to the FY2015 final rule that a patient’s move to inpatient care does not necessitate a change in attending physician.
Specifically, CMS wrote:
“A hospice patient is not required to change his or her attending physician in order to receive inpatient care, regardless of the setting. If the attending physician does not have privileges at the hospital(s) the hospice contracts with for inpatient care, or does not wish to care for the patient in an inpatient setting, then according to our CoPs at § 418.64(a)(3), the hospice physician or NP [nurse practitioner] must provide any needed physician’s services. The patient does not need to designate the hospice physician or NP as his or her attending physician for this to occur.
However, while the hospice can bill Medicare Part A for its employed or contracted physicians providing needed physician services to its patients, it can only do so for its NPs if the NP is the designated attending physician. This limitation on hospice NP billing is in the hospice regulations at § 418.304(e) and is based on the statutory language surrounding physician billing. The statutory definition of ‘‘physician services’’ at section 1861(q) of the Act requires that the individual performing the services be a physician. ‘‘Physicians’’ are defined at section 1861(r) of the Act, and do not include NPs. However the statute does permit attending physicians to bill for their services at section 1812(d)(2)(A) of the Act, and defines attending physicians to include NPs at section 1861(dd)(3)(B) of the Act.
We noted in the preamble of the proposed rule that ‘‘attending physician’’ is defined differently in different settings. If the patient is in a hospital, the hospital may assign a hospitalist to the patient, and the hospital may consider that hospitalist to be the ‘‘attending physician.’’ However, that individual does not meet the hospice definition of ‘‘attending physician’’ unless the beneficiary chooses the hospital assigned attending physician to be their hospice attending physician. The clinician who meets the hospice definition of ‘‘attending physician’’ should provide needed care to the hospice patient in the hospital.
If that hospice attending physician is unavailable, then the hospice physician or NP would need to do so. The hospice should coordinate the patient’s care during the inpatient stay by communicating with the hospitalist. If the hospice attending physician is involved in the patient’s care during an inpatient stay, that hospice attending physician will need to coordinate with any hospitalists that the hospital may have assigned, and of course with the hospice.”
NAHC and its affiliate Hospice Association of America (HAA) encourages its members to review this clarification in order to be fully complaint with the new regulations as it pertains to the new rules surrounding attending physicians and hospices.