Billing Aetna for non-hospice related surgery

[KSzy]

I'm hoping someone can point me in the right direction, I don't have much experience with hospice. Patient has Aetna PPO Medicare Replacement/Advantage plan.

My doc performed an ORIF for fractured femur after seeing pt in ER. I billed Aetna and turns out she's on hospice. I added the GW modifier because the condition was not related to her hospice and Aetna is still denying stating "patient is enrolled in a hospice". They are not giving more detail, even on a call. After searching on here and Aetna's policies, it looks like I should be billing Medicare instead? Is that correct? If so, do I bill them with the GW modifier?

 

[trarut]

Hospice is a service that was carved out of the Medicare Advantage contracts. When a patient enters hospice, their Medicare Advantage coverage ends and they revert to traditional Medicare coverage. I would resubmit to Medicare, using any appropriate modifiers. The circumstances haven't changed - the surgery is still unrelated to the reason for the hospice stay.