What Is the Current Status of NP Billing for Hospice Care?

Carolyn Buppert, NP, JD


July 29, 2004


What is the current status of nurse practitioners (NPs) regarding the provision of and billing for hospice care? Can NPs now direct and/or manage hospice care, once a physician has certified eligibility? Also, what happened to the Rural Provider Equity Act (S. 1185 and H.R. 2333), initiated in June 2003, which considerably expands NP responsibilities and compensation? Has it passed? How does it affect the provision of hospice care?

Response from Carolyn Buppert, NP, JD

Response from Carolyn Buppert, CRNP, JD
Nurse practitioner and attorney who specializes in the legal issues affecting medical practices and nurse practitioners. She is the author of 5 books. Ms. Buppert counsels clients, and lectures extensively on reimbursement issues, how to avoid malpractice, and contract negotiation. She is also president of Better Life Health Care Systems, which contracts with businesses and educational institutions for nurse practitioner services. Through that company she serves as Director of Student Health at St. John's College in Annapolis, Maryland. Her Web site is www.buppert.com


As of December 8, 2003, NPs may be the "attending physician" for patients who have enrolled in hospice. Prior to that, only physicians could be the attending physicians for hospice patients.

A patient who has elected hospice may use the medical director of hospice or may keep his/her own provider as the attending physician. The patient must identify the attending physician at the time he/she enters hospice. Under the new law, patients may select an NP as their attending physician, and NPs may bill Medicare Part B for physician services related to their hospice patients' terminal illnesses. Hospice medical directors may bill for physician services to hospice patients; however, those services are paid by Medicare Part A.

The Medicare Prescription Drug Act did not change the law that only a physician may certify that a patient has a terminal illness and that only a physician may be the medical director of hospice and serve as the physician member of the hospice interdisciplinary committee. However, an NP may serve as the nursing member of the committee.

Patients covered by Medicare who have been certified by a physician as terminally ill may elect hospice. Doing so means that the patient may have the following services and supplies reimbursed under Medicare Part A:


  • Medical care, through the hospice medical director;

  • Nursing care;

  • Pharmaceutical therapy for pain relief and symptom control;

  • Home health aide and homemaker services;

  • Social work services;

  • Physical and occupational therapy;

  • Speech therapy;

  • Diet counseling;

  • Bereavement and other counseling services; and

  • Case management.

You also asked about the status of the Rural Provider Equity Act (S. 1185 and H.R. 2333). If passed, this act would change physician-only language to include "clinical nurse specialist," "physician assistant," and "nurse practitioner" in certain US Code sections applicable to home healthcare, hospice, and skilled nursing care. The bills have not passed. The bills were referred to committees in both the Senate and House of Representatives and remain there, as of this date. For bill status, visit




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