Ala. Admin. Code r. 560-X-51-.11

Current through Register Vol. 42, No. 12, September 30, 2024

Section 560-X-51-.11 - Reimbursement For Physician Services

The basic payment rates for hospice care are designed to reimburse the hospice for the costs of all covered services related to the treatment of the beneficiary's terminal illness, including the administrative and general supervisory activities performed by physicians who are employees of or working under arrangements made with the hospice. Group activities, which include participation in the establishment of plans of care, supervision of care and services, periodic review and updating of plans of care, and establishment of governing policies are included in the reimbursement rates for routine home care, continuous home care, and inpatient respite care. Direct patient care services by physicians are reimbursed as follows:

(1) Payment for direct patient care services rendered by physicians employed by or working under arrangements made with the hospice may be billed by the physician with the hospice provider indicated as the payee. Services furnished voluntarily by physicians where the hospice has no payment liability are not reimbursable.

(2) Services provided by the patient's attending physician who is not an employee of, or receiving compensation from the hospice for services provided for the hospice, will be paid to that physician in accordance with the usual billing procedures for physicians.

Author: Theresa D. Richburg

Ala. Admin. Code r. 560-X-51-.11

Emergency rule effective October 1, 1990. Permanent Rule effective February 13, 1991.

Statutory Authority: Title XIX, Social Security Act; 42 C.F.R. §418.304; State Medicaid Manual; State Plan.