Current through Register Vol. 54, No. 7, April 4, 2022
of calculation of the basic per diem rates for hospice services listed in
includes the costs of
the administrative and general supervisory activities performed by physicians
who are employees of the hospice provider or those working under financial
arrangements with the hospice provider.
administrative and supervisory activities are generally performed by the
physician serving as the Medical Director and/or the physician member of the
hospice interdisciplinary group.
Interdisciplinary group activities include participation in the establishment
of plans of care, supervision of care and services, periodic review and
updating of plans of care, and the establishment of governing
The Division shall pay the physician for only direct patient care services
furnished to Medicaid/NJ FamilyCare FFS hospice beneficiaries by hospice
physician employees, and for physician services furnished under arrangements
made by the hospice, unless the services were provided on a volunteer basis.
The cost of the direct patient care services of the physician who is employed
by or under contract with the hospice agency shall be submitted on the CMS 1500
claim by the physician to the fiscal agent.
Physician services furnished on a volunteer basis are excluded from Medicaid/NJ
FamilyCare FFS reimbursement.
The physician may bill for services which are not provided on a volunteer
basis. However, the physician shall treat Medicaid and NJ FamilyCare FFS
beneficiaries on the same basis as other beneficiaries in the hospice. For
instance, a physician may not designate all physician services rendered to
non-Medicaid patients as volunteered and at the same time seek payment from the
hospice for all physician services rendered to Medicaid and NJ FamilyCare FFS
attending physician shall bill only for direct personal care services and not
for other costs such as laboratory or X-rays, which are to be included in the
hospice per diem rate.
1. The costs of
attending physician's direct personal care services shall not be included in
the hospice cap determinations.
Attending physician services and other
specialty physician services, including consultation services provided by
physicians who are not employees of the hospice, are reimbursed as covered
services on a fee-for-service basis under N.J.A.C. 10:54, Physician Services,
separate from the method of calculation of the hospice per diem rates listed in
1. The hospice shall state the name of the
physician who has been designated the attending physician (whenever the
attending physician is not a hospice employee) in the plan of care and on the
Election of Hospice Benefits Statement, FD-378; and specify whether the
attending physician services are either related or unrelated to the
beneficiary's terminal illness.
N.J. Admin. Code §
Amended by R.1997 d.479,
See: 29 N.J.R. 3441(a), 29 N.J.R. 4853(a).
R.2003 d.320, effective 8/4/2003.
See: 34 N.J.R. 2899(a), 35 N.J.R. 3568(a).
Amended by R.2008 d.226, effective
N.J.R. 1582(a), 40 N.J.R. 4578(a).
In the introductory paragraph
of (b), substituted "CMS" for "HCFA"; and in (d)1, deleted "(2/02)" following