Practice Management Alert

Question: The physicians at our practice treat patients in the office as well as at nursing homes and hospitals. Some of the patients we treat are under hospice care. Claims we submit to Medicare for these patients are always denied, and Medicare says this is because the patient is being treated under hospice. What is the best way to win reimbursement for these claims?

South Carolina Subscriber

Answer: Getting reimbursed for a hospice Medicare patient requires you to define the hospice status of your physician. "Some doctors are contracted by hospice to provide services to the patients," says Tammy Thompson, office manager of the Respiratory Disease Clinic in Paducah, Ky. "Attending doctors" is the term used to refer to these doctors. For example, hospice would contract an oncologist to be the attending doctor for a patient with terminal cancer, Thompson says. You should bill the hospice directly if your physician is contracted as an attending doctor.

If your physician is not contracted as the hospice patient's attending physician, "You will need to get a UB92 form from the hospice and send [that] along with your Medicare claim," Thompson says. You should also write "Doctor is not hospice doctor" in block 19 of the HCFA-1500 form, she adds. And you'll need to add HCPCS modifier -GV or -GW to the E/M service or procedure code:

-- modifier -GV (Attending physician not employed or paid under arrangement by the patient's hospice provider).

-- modifier -GW (Service not related to the hospice patient's terminal condition).