Wiki Billing when pt has active coverage in hospice

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mishortho@sbcglobal.net

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Hello, we have a patient that came in for office visit, xrays, and injection. She has traditional medicare and the claim came back as denied since pt has active coverage in hospice. When our billing department called on the claim they suggested we either add modifier QW or QV. Can someone explan this to me? And also, does the modifier go on everything or just the E/M code?
 
Here are two good MAC resources for -GV vs -GW since I don't know where you're located/which MAC applies.
Basically, the PROFESSIONAL services provided are billed to Medicare with the appropriate modifier. The TECHNICAL components are billed to the hospice. If you did not contact the hospice prior, you may have difficulty getting any payment from the hospice.
 
This is new to me. I have a Medicare Replacement policy in the state of NH and my claims are denying with the GW modifier although I contacted the carrier and this was the information provided to me. Should these claims be going to Medicare rather than the replacement policy? Thanks for any help with this.
 
newfiegirl said:
This is new to me. I have a Medicare Replacement policy in the state of NH and my claims are denying with the GW modifier although I contacted the carrier and this was the information provided to me. Should these claims be going to Medicare rather than the replacement policy? Thanks for any help with this.
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With a MA plan you still need to bill traditional Medicare for Part B services that are not related to the patient's hospice condition with modifier GW and then Medicare will process the claim, it should be denied. Once you have the MEOB showing the claim was denied by traditional Medicare then you can submit it to the MA plan for processing. I used to work in my companies claims department processing these types of claims for our MA members and we had to have the MEOB showing that traditional Medicare considered the claim before we could even consider applying the MA plan benefits to the claim.

I will caution you that sometimes traditional Medicare decides to pay on a claim with a GW modifier appended to it and you have to contact your Part B MAC to figure out why and get it corrected before the MA plan will pay on the claim.
 
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