Wiki Gw modifier for non-hospice claims

[ragivens]

I am having some issues with getting payment from Medicare Advantage plans for non-hospice related claims. My physicians do not bill for hospice related diagnosis and are not hospice physicians. The claims I bill have the appropriate GW modifier and some will pay while others deny stating bill traditional Medicare. On several that have paid I am now receiving a request for monies back referring to the CMS Processing Manual CH. 11. Section 30.4 which states to bill traditional Medicare. However, if you read just below that section in the billing sub-category is states to bill non-hospice related claims with the appropriate GW, GV modifiers. Perhaps I'm misinterpreting the CMS Manual and am looking for clarification. I would greatly appreciate any advice!

 

[philipwells]

Your situation sounds like mine in regards to our physicians and their affiliation with a hospice carrier. Say for example the patient has a Medicare HMO (BCBS Advantage). Check their Medicare eligibility using there Medicare number to see when their hospice election date range is first. If your physician's charges fall within that range on the Medicare common working file then you will bill all your charges to standard Medicare with a GW modifier.

The main thing is, if the patient is in the hospice election period, you have to bill Medicare even if they have an active HMO. Medicare CWP will have the hospice election dates.