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medicare billing when hospice is involved.

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rdmoore2003:
if a mental health client has medicare but has signed on to hospice care for 30 days, which modifier is to be used for medicare?   Medicare says there is a modifier for this, because we are a provider for other services that has nothing to do with hospice

Pay_My_Claims:
hummmmmmm I am curious about that because from my experience when it's not related to hospice (when I billed for hospital admissions) we had to get hospice to either agree to pay our rates or d/c the hospice until we could bill the  admit. With DME i have had the hospice pay us and they file the claim for reimbursement. I have never heard of a modifier that can be used to bill when a client is under hospice. I have always known that once they are hospice, all care is the responsibility of the hospice organization.

PMRNC:

--- Quote ---I have always known that once they are hospice, all care is the responsibility of the hospice organization.
--- End quote ---

That's correct!

Linda Walker
PMRNC
www.billerswebsite.com

Pay_My_Claims:
*wipes forehead* Thanks Linda

Michele:
The modifier you are looking for is GW- service unrelated to terminal condition.

I understand that if the care is completely unrelated to the terminal condition it can be billed using the GW modifier.  I have actually billed services out that have been paid, and I got the information from Medicare. 

Personally, it doesn't make sense to me.  When we got hospice for my grandfather we were told that we could only provide comfort care, and it seems that any care unrelated to the terminal condition would fall outside of that, but I have seen many cases of services being billed with the GW and being paid.

I'd love to hear if others have any info/experience with this.

Michele

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