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WHAT CODE TO USE ON FORM UB 92 FOR HOSPICE PATIENTS

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Michele:
The GW Modifier is used to indicate - Service not related to the hospice patient’s terminal condition.  If the services you are billing are not related to the Hospice condition then the GW modifier will work.

Thanks for the info!

Michele

Jane:
I bill for a doctor who is not employed by the hospice organization but is listed as the attending physician for the hospice patient seen in a nursing home setting.  On occasion his employee, a nurse practitioner, will see a hospice patient.  Although I have received payment for her visits, more often they are denied.  Medicare said that only the physician can bill for hospice related diagnosis and the Q5 modifier is for physicians only and not a NP.  Any suggestions for a solution?

Michele:
Medicare does allow NP's to bill for services to Medicare beneficiaries who have enrolled in hospice program if the NP is the 'attending physician'.  It sounds like the problem is because the NP is not the 'attending physician' but that her employer the MD is.  I would recommend contacting Medicare to see if there is anyway that you can indicate that the NP is an employee of the attending physician or if the billing can be done under the MD since he is the employer of the NP.

Michele

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