Wiki Hospice vs Skilled nursing faculity

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ywalker

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There is no modifier that specifies SNF when the patient is a resident. I have been using the modifier GV, but the patient is not in hospice so what modifier can I use to get my claims paid when the patient comes to see the Doctor not being paid by the hospice provider. This is a Medciare patient.
 
Just to make sure that I am understanding you correctly before I answer, the patient is or is not currently enrolled in hospice services?
 
Hospice vs Skilled Nursing Facility

The patient is not enrolled in hospice, but is in a skilled nursing facility and comes to see the doctor for other services not offered at the nursing facility.
 
When we have a patient (Medicare) in a skilled nursing facility, we set up a case number in our system. Under this case number the SNF gets billed for the providers services...not Medicare. The SNF will then in return bill Medicare.

There are certain services that get billed this way, however, office visits are not one of them. You will have to check Medicare's website for which services should be billed to the SNF.

I have never had a problem though, getting paid for an office visit when a patient is in a SNF. Also, we do not use a modifier for these. I hope this helps.
 
modifier for injection when patient is at SNF

The MD took an injection to a patient at a SNF and gave to patient directly. Medicare paid for the injection but is now requesing refund b/c patient was subject to consolidated billing and should not be paid separatly. What modifer should I be using so I can get the injection reprocessed?
 
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