Wiki Billing for Hospice patients

[Lou Hood]

My provider visits nursing homes and sometimes see's patient that are covered by Hospice. Most of these visits go unpaid, the denial reason given by Medicare is incorrect insurance package was chosen. She can't bill under Medicare A as she isn't the facility or an employee of the facility. So we bill under Medicare B and I'm thinking the denials are because she isn't the patients chosen provider at the time that the patient entered into hospice. Does anyone have any further information or experience with this?

 

[Coder2468]

I don't have experience with hospice billing, but would using modifier GV help you? "Attending physician not employed or paid under arrangement by the patient's hospice provider".

 

[lcicchitto]

The GV*modifier is used*when a physician is providing a service that is related to the diagnosis for which a patient has been enrolled into hospice. This physician is not associated with the hospice, and is providing services as the attending physician.

The GW modifier is used when a physician is providing a service that is not
related to the diagnosis for which a patient has been enrolled into hospice. This physician is not associated with the hospice, and is providing services as the attending physician.
When a patient is under hospice, there is a certain diagnosis that was indicated at the beginning of care.*If the*service*the physician*renders is unrelated to the terminal illnesses that hospice has on record,*Medicare will not reimburse for the service unless it is submitted with the modifier GW.* The GW modifier cuts through the*Medicare edits and will pay.

Hope this helps.

 

[Lou Hood]

Using the GV and GW doesn't seem to make a difference. The denial that I get back is that I'm using the incorrect insurance. I'm thinking they want be to use Medicare A but we can't as we're not a facility.

 

[jamievserrano@gmail.com]

Help: Hospice billing PLEASE!

I work for a hospice company. We seem to be having an issue with the way we are reporting the physician visits.

For example: patient is admitted on services on 01/01/2017. Patient received core services, billed as RHC routine home care (revenue cide 651) for DOS:01/01-01/04. On 01/05 physician (who works under our group/billing NPI because he is employed by hospice company) visits patient and therefore reports and evaluation and management code. Should this be an initial visit or a subsequent visit?

01/05 is truly the first time the physician sees the patient. 01/01-01/04 patient was not seen by physician, rather a nurse and that is why we report 651 for the day providing hospice care (nurse visits, anything to make them comfortable)

When billing a commercial carrier, in which we are contacted to receive seperate reimbursement for physician visits, we are reporting initial visit and DOS remains denied because carrier is stating patient was established as of 01/01...

Can you please shed some light as I have tried to wrap my brain around it and cannot. We have people here insists it should be an initial but carriers across the board denial raise questions. Should we fight this decision or are they correct in denying?

Could we be reported Incorrectly? We are billing both service on same claim with the companies group NPI and TAX ID combo as the physician is contacted by the group. And the physician code is being submitted with revenue code 657 and the appripate CPT in accordance with complexity.

Please help!