Marilyn Posted Tue 23rd of July, 2013 23:20:22 PM
Medicare denied a claim in ref to "Patient is enrolled in a Hospice".
What does this mean? My doctors office is Family Practice.
SuperCoder Answered Tue 23rd of July, 2013 23:24:16 PM
You would report the GW modifier (service not related to the hospice patient's terminal condition) if the service was unrelated to the hospice condition.
Use of Modifiers in Billing Hospice Claims
GV The attending physician should use this code to indicate "Attending physician not employed or paid under agreement by the patient's hospice provider" when billing his/her professional services furnished for the treatment and management of a hospice patient's terminal condition. Modifier GV should be used after each procedure code billed.
GW Should be used when services are not related to a hospice patient's terminal condition.
Please follow these basic guidelines when determining whether claims should be sent to Medicare Part B or Hospice:
· If the beneficiary is seen by any physician other than his/her primary attending physician for a hospice diagnosis, submit to Hospice.
· A lab claim submitted with a diagnosis different than the hospice diagnosis, should be submitted to MEDICARE PART B. When submitting a claim to MEDICARE PART B, an independent lab must report a specific diagnosis. A claim submitted with diagnosis V72.6 will be denied.
· If the beneficiary is seen by a physician other than his/her primary attending physician for any diagnosis other the hospice diagnosis, submit the claim to MEDICARE PART B.
· If the beneficiary is seen by his/her primary attending physician for any diagnosis, including the hospice diagnosis, the claim should be submitted to MEDICARE PART B.
· However, if the beneficiary's primary attending physician has a contract with HOSPICE and is employed by HOSPICE, the claims will be submitted by the HOSPICE agency to HOSPICE.
· If a consulting physician is taking the place of the primary attending physician or overseeing the beneficiary's care while the primary attending physician is not available, submit the claim to MEDICARE PART B even if the diagnosis is the hospice diagnosis. This information must be stated on the claim form or the claim will be denied.