Do hospice home visit physician visits count as separate entities or are they based on previous and subsequent visits?

Hospice Home Visit Physician Billing and Documentation

Hospice physician home visits are counted and billed as individual, separate encounters rather than being aggregated across previous or subsequent visits. Each visit stands alone as a distinct service event for documentation, billing, and quality measurement purposes.

Understanding Hospice Physician Visit Structure

Individual Visit Counting

• Each physician home visit to a hospice patient is documented and counted as a separate, independent encounter 1
• Hospice services typically provide home visits by generalist physicians primarily for recertification purposes, with each visit serving a distinct clinical and administrative function 1
• The Medicare hospice benefit requires physician certification and oversight, with each visit documented separately to demonstrate ongoing medical necessity 2, 3

Regulatory Framework for Visit Documentation

• Medicare-certified hospices must document physician involvement through individual visit records, with recertification required at specific intervals (typically every 60 days for the hospice benefit) 2, 3
• The attending physician is expected to remain in charge of the patient's care, write orders, and see the patient for visits, with each encounter documented independently 4
• Physicians must certify that services are needed and establish a plan of care that is reviewed every 60 days, but individual visits between these certification periods are still counted separately 3

Clinical Context of Physician Visits

Visit Frequency and Patterns

• Research demonstrates significant variation in hospice professional staff visits during the last days of life, with 12.3% of patients receiving no professional staff visits in the last 2 days 5
• In the last week of life, 44% of hospice decedents had at least one in-person visit by a registered nurse or social worker, though physician visit patterns differ from nursing staff patterns 6
• Physician home visits in hospice settings typically address symptom management (most commonly pain), medication review, and patient/family education, with an average of 2.8 symptoms addressed per visit 7

Purpose of Individual Visit Counting

• Each visit serves distinct clinical purposes including symptom assessment, medication adjustment, family education, and documentation of disease progression 7
• The hospice interdisciplinary team approach requires coordination among physicians, nurses, social workers, and other professionals, with each discipline's visits tracked separately 1
• Individual visit documentation allows for quality measurement, appropriate resource allocation, and demonstration of medical necessity for continued hospice services 5, 6

Practical Implications

For Billing and Reimbursement

• Medicare reimburses hospice care through a per-diem payment system rather than fee-for-service for individual visits, but visit documentation remains essential for quality oversight 5, 6
• While the hospice per-diem covers all services related to the terminal illness, individual physician visits must still be documented to demonstrate appropriate care delivery 4
• The Service Intensity Add-on (SIA) payment introduced by CMS in 2016 specifically requires documentation of individual in-person visits by registered nurses or social workers in the last 7 days of life 6

For Quality and Continuity of Care

• Regular communication between the physician and hospice team requires documentation of each encounter to ensure appropriate clinical care 3
• Primary care physicians who serve as attending physicians for hospice patients must maintain records of each visit for continuity and coordination purposes 3, 4
• Visit frequency and documentation patterns vary significantly by hospice program, geographic region, and patient characteristics, making individual visit tracking essential for quality improvement 5

Common Pitfalls to Avoid

• Do not assume that hospice recertification visits substitute for or aggregate other physician encounters—each visit requires separate documentation 3
• Avoid gaps in visit documentation, particularly in the final days of life when symptom management needs are highest 5
• Be aware that visit patterns may be influenced by day of the week (Sunday visits are less common) and care setting (nursing home patients receive fewer visits than home-based patients) 5
• Ensure that physician involvement is clearly documented separately from nursing and social work visits, as different disciplines serve complementary but distinct roles 1