Hospice is a specialized form of medical care focused on providing comfort and improving the quality of life for a person with a terminal illness. The goal shifts from attempting to cure the disease to managing symptoms and offering comprehensive support for the patient and their family. While the hospice agency supplies a dedicated care team, a patient retains the right to see their own doctor. This process operates under specific rules, depending on the doctor’s willingness to coordinate and whether the medical issue relates to the terminal diagnosis.
The Hospice Medical Director and Team
The medical authority within the hospice program rests with the Hospice Medical Director, a physician who oversees all patient care. This director formally certifies the patient’s terminal illness, defined as a life expectancy of six months or less if the disease runs its natural course. The Medical Director regularly reviews and approves the comprehensive plan of care developed by the interdisciplinary team. They act as a central medical liaison, consulting with the patient’s personal doctors and ensuring the care aligns with palliative goals.
Day-to-day medical management is primarily handled by the Registered Nurse (RN) Case Manager, the patient’s most frequent point of contact. This nurse coordinates all services, equipment, and medications, functioning as the central hub for symptom management. The RN Case Manager works closely with the Medical Director to adjust the care plan as the patient’s needs change. This internal team structure provides continuous medical oversight, often available twenty-four hours a day.
Continuing Care with Your Attending Physician
A patient has the right to select an Attending Physician, who may be their long-time primary care doctor or a specialist, to help supervise their care during the hospice period. This external doctor is often referred to as the Attending Physician. Their role is to collaborate with the hospice team on the patient’s care, particularly for issues stemming from the terminal illness. This physician must agree to coordinate with the Hospice Medical Director and the interdisciplinary team to ensure a unified approach.
When the Attending Physician provides a service related to the terminal diagnosis, such as an evaluation and management visit, they can bill separately to Medicare Part B. To receive payment, they must use a specific modifier code, such as “GV,” indicating they are the patient’s selected physician who is not a hospice employee. This allows the patient to maintain a relationship with their trusted physician while the hospice team provides the core services. If the patient has not designated an Attending Physician, the Hospice Medical Director assumes full responsibility for the physician component of care. The patient must formally choose their Attending Physician, and this choice is documented on the hospice election statement.
Covered Services: Care Related to the Terminal Diagnosis
Once a patient elects the hospice benefit, they agree to receive palliative, non-curative care for their terminal illness and related conditions. This election triggers a shift to a bundled payment system, where the hospice agency receives a fixed daily rate (per diem) to cover all services. The hospice is financially responsible for everything related to the terminal diagnosis, including nursing care, medications, medical equipment, and supplies. Therefore, any physician services for the terminal illness must either be provided by the hospice team or coordinated and billed by the Attending Physician.
If a patient seeks outside treatment or sees a specialist for the terminal diagnosis without hospice approval, that care will not be covered by Medicare or other insurance. The benefit election requires that all care for the condition that qualified the patient for hospice must be managed by the hospice agency. This regulation prevents duplication of services and ensures all medical interventions align with the comfort-focused plan of care. Seeking curative treatment outside of the hospice framework may result in the patient being financially liable for the full cost of that treatment.
Seeking Treatment for Non-Hospice Conditions
The restrictions on seeing outside doctors only apply to the terminal illness and its associated conditions. A patient retains the right to receive medical care for any conditions certified by the hospice team as unrelated to their terminal diagnosis. This distinction allows patients to continue necessary routine medical management or receive acute treatment for separate issues. For instance, a patient on hospice for terminal lung disease who breaks a bone or develops a severe, unrelated infection can seek treatment from an outside doctor or specialist.
Care for these unrelated conditions is covered under the patient’s standard insurance, such as Medicare Part A or Part B, or a Medicare Advantage plan. The Attending Physician or any other specialist treating an unrelated condition will use a different billing modifier, such as “GW,” to signal that the service is separate from the terminal illness. This ensures the service is reimbursed through the patient’s regular medical coverage, not the hospice benefit. The hospice team will work with the outside provider to ensure the unrelated care does not conflict with the palliative goals of the hospice plan.