Medical Billing Forum

Coding => Coding => Topic started by: kbunn on May 28, 2010, 11:07:54 AM

Title: Hospice Revocation
Post by: kbunn on May 28, 2010, 11:07:54 AM
I bill Medicare for services and Medicare denies (B9) patient enrolled in hospice. I am aware that the GW modifier can be appended to let Medicare know that the services rendered are not related to the patient's terminal illness. Here is my problem: Patient is no longer in hospice but the hospice WILL NOT close the case. Therefore, Medicare continually denies all charges billed to Medicare. I do not want to append the GW modifier if the patient is no longer in hospice or never was in hospice because I feel that is fraudulant billing. Am I correct in my thinking? Would this be fraudulant billing by using the GW when the patient is not in hospice? Do I have any other options? Please help, thanks.
Title: Re: Hospice Revocation
Post by: Pay_My_Claims on May 28, 2010, 11:55:44 AM
I don't think it is. there isn't much you can do if the hospice won't update the CWF, but you can however contact the patient and have them call Medicare. They should also be able to have that done. Let the patient know you are having problems with the billing because of what his hospice group is stating (he is enrolled), they don't want him to call Medicare.
Title: Re: Hospice Revocation
Post by: kbunn on May 28, 2010, 12:26:23 PM
Thanks for responding. We have tried that, with the patient calling Medicare. The patient has called Medicare and SSA. As of today, case is still open. This has been going on for many months now, and the daughter of the patient has told me that this has been going on for years. We were worried that by adding the GW, we were agreeing that the patient was still in hospice, when the patient IS NOT in hospice, but IS STILL enrolled because the hospice won't revocate. Thanks for your reply. I will ask the patient to call Medicare again and this time, the patient needs to "report" the hospice.  Has anyone out there heard about some new regulations that the hospices will be mandated to follow as far as revocation?
Title: Re: Hospice Revocation
Post by: Pay_My_Claims on May 28, 2010, 03:48:34 PM
I have never had this issue with hospice. most are very great to work with. the GW only stipulates the care ISN'T related to why they were under hospice. If they are enrolled or not has NOTHING to do with your claim. Now it would be FRAUD if you treated them for something related to their hospice, and you knowing they are not in hospice, append the modifier just to get the claim paid. Also when I worked inpatient, what I did was file the claim to hospice, get the denial then send the claim to Medicare along with the denial. The hospice has to deny the claim or pay.