Hospice Billing Basics for e-MDs Practices

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Hospice:  It’s a word that no one wants to hear, especially when it comes to your loved ones because it means the life of someone dear is coming to a close.  Having said that, hospice services provide much needed comfort to patients and their families during a difficult time. Billing for hospice services can be a bit tricky.  Here are some general rules to follow:

From a billing perspective, providers need to know the reason for the patient to be enrolled in hospice so that they can add the appropriate hospice modifiers.   There are several modifiers that are generally used:

Modifiers

  • GV– The attending physician is not employed or paid under the agreement by the patient’s hospice provider.
  • GW– The service is not related to the hospice patient’s terminal condition
  • Q5– The service is furnished by a substitute physician under a reciprocal billing arrangement
  • Q6– The service is furnished by a locum tenens physician

Process

  • Append the GV or GW modifiers only when a patient is enrolled in a Medicare certified Hospice.
  • The services of the attending physician are billed to Medicare Part B with the GV modifier– Attending physician not employed or paid under agreement by the patient’s hospice provider as long as the provider does not have a payment arrangement with the hospice. If there is an agreement in place, then the hospice agency includes the attending physician services in its services billed to Medicare Part A.
  • The beneficiary waives all rights to Medicare Part B payments for services except for professional services of an “attending physician.” (In this case “attending physician” is defined as a doctor of medicine or osteopathy or nurse practitioner who is identified as having the most significant role in the determination and delivery of their medical care.)
  • Modifier GW is used when a provider of services (physician, ambulance supplier, etc.) performs services not related to the hospice diagnosis. Certain Medicare beneficiaries can choose hospice benefits instead of Medicare for treatment and management of their terminal condition.
  • If a substitute or locum tenens physician provides services, the designated attending physician bills the services using modifier GV and either the Q5 or the Q6 modifier.

Remember that claims for these patients should be filed to the Medicare carrier in the state services were rendered and not filed directly to hospice. Let us know if we can be of assistance to your practice by filling out the form below.

Solor is a specialized third party medical billing company for e-MDs® Practices.  e-MDs® is a registered trademark of e-MDs Inc.  e-MDs Inc. is not affiliated with Solor, Inc., our products, services, or website.  Additional legal disclaimer here:  http://wp.me/P7cvJE-kI

Sources: WPS Medicare http://bit.ly/21qJSWI

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