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Home Health & Hospice Week

Referrals:

SCORE POINTS WITH REFERRING DOCS WITH HOSPICE BILLING TIPS

Published on Tue Jun 13, 2006

Physicians should master 4 modifiers to ensure payment for hospice patients.

If you're not helping your referring physicians bill successfully for their hospice patients, you're missing out on a golden marketing opportunity.

Billing for hospice patients can seem frustratingly complex to physicians. Patients will have an attending physician and a medical director, and Medicare Part B carriers can make your referring physicians jump through hoops to obtain reimbursement.

Here are some tips you can pass on to navigate the physician hospice payment maze--and to help you get into your referral sources' good graces.

Tip: Referring physicians not directly employed by the hospice should use these four modifiers, according to hospice billing experts:

• GV: The physician's services were related to the patient's terminal illness. This modifier on its own also means the doc was the patient's attending physician.

• GW: The physician's services were unrelated to the patient's terminal illness.

• Q5: Another physician in the same practice is covering for the patient's attending physician.

• Q6: Another physician in a different practice is covering for the attending physician.

Pay attention: If your referring physician uses the GV and Q5 modifiers together, then it means the services were related to the terminal illness, but a colleague was covering for the attending physician.

Under Medicare, the patient has to choose an "attending physician" when she enters hospice care.

The hospice medical director provides administrative and general oversight of the program, but the attending physician performs all hands-on care, explains coder Linda Zimmerman with Internal Medicine Associates of Bloomington, IN. If the attending works for the hospice, then the hospice bills Part A. If not, the attending can bill Part B directly using the evaluation & management codes and the GV modifier.

Important: Docs have to use the GV or GW modifiers for the attending physician's services, or they won't get paid.

Place matters: Physicians have to have the correct place of service (POS) on their claims for hospice patients. For a patient admitted to a hospice, they won't get paid unless they use POS code 34. They could also have hospice patients receiving services in their homes (POS code 12), in skilled nursing facilities (POS code 31) or in the hospital (POS code 21).

Example: Kansas City Neurosurgery sees a lot of terminal cancer patients for back problems, according to coder Rena Hall. Often, the patients have back pain related to a degenerative disc disease, so the practice uses the GW modifier on the claim to indicate the diagnosis is unrelated to the hospice diagnosis. If her physicians did see patients for back pain related to vertebral metastases or another related diagnosis, then she would use the GV modifier.

Tip: When using the GV modifier, tell physicians to make sure they use the exact diagnosis that the hospice submitted to Medicare as the covered diagnosis, Jones warns. If the diagnosis is close to the hospice diagnosis, but not exactly the same, the carrier may not cover the claim using the GV modifier. For other diagnoses, try the GW modifier.

Another tip: Advise physicians to use the Q6 modifier when a locum tenens physician is standing in for one of the docs in the group, advises Donna Beaulieu with Quality Physician Services in Stockbridge, GA.

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