FAQs For Physicians
Q. Can a patient choose a Nurse Practitioner as their attending physician in Hospice?
Hospice Medicare A Beneficiaries may choose to have a nurse practitioner serve as their attending; however, a nurse practitioner may not sign a physician certification of terminal illness.
A. The medical director may engage the attending physician at any time via face-to-face meeting, telephone conference, and/or written communication.
Q. What are the Four Levels of Hospice care?
A. The Hospice Medicare A benefit provides for four levels of care including the following:
• Routine Home Care;
• Continuous Home Care;
• Inpatient Respite Care; and
• General Inpatient Care.
Q. What are the Responsibilities of a Physician?
A. A hospice beneficiary must be certified as terminally ill. It is the responsibility of the medical director, in collaboration with the attending physician, to assess the patient's medical condition and determine if the patient can be certified as terminally ill. Then, both the medical director and the attending must certify the patient has a terminal illness with a prognosis of 6 months or less, if the illness were to run its normal course.
A physician making the determination to certify as terminally ill must consider the following: primary diagnosis of the terminal condition; secondary diagnoses related to the primary terminal condition; comorbidities; current clinically relevant information supporting the certification.
Q. What if a physician serves dual roles as both the Attending Physician and Medical Director?
A. If the medical director is also the attending physician and the relationship is documented accordingly in the medical record, then only one signature is necessary for initial certification.
Q. What is an Attending Physician?
A. An attending physician is defined as a doctor of medicine or osteopathy that is identified at election of hospice care to be the physician with the most significant role in the determination and delivery of the individual terminal medical care. The attending physician continues to be responsible for providing primary medical care to the beneficiary and is supported by the interdisciplinary team and the hospice medical director. The attending physician is required to certify the beneficiary’s terminal illness for the initial benefit period.
Q. What is involved with Physician Certification?
A. The initial certification of terminal illness MUST be in writing by the medical director AND the attending physician. Recertification only requires the medical director’s signature. The required elements of certification include the following: six months prognosis statement; primary terminal diagnosis; name of beneficiary; physician(s) signatures – must be dated & written; the reference period; and all necessary accompanying documentation supporting determination of terminal illness.
Q. When may a patient revoke the Hospice Medicare Benefit?
A. A beneficiary or representative may revoke the Hospice Medicare Benefit at any time for any reason, after which regular Medicare A benefits will be reinstated. When a beneficiary chooses to revoke the Hospice Medicare benefit, he or she must sign a revocation form.