LADY_SETSUNA_CJ
Guest
I work at a dialysis facility and we are having difficulties with our Hospice and getting claims paid.
The big question, WHO PAYS?
I have three scenarios...
1) Patient in hospice due to Dx1: Cardiovascular Disease Dx2: ESRD. Primary payor MHMO
2) Patient in hospice due to Dx1: Cardiovascular Disease Dx2: Unknown. Primary payor Commercial Insurance.
3) Patient in hospice due to ESRD. Primary payor MHMO
We've received conflicting answers. I have some stating that Medicare should be billed for ESRD with certain condition codes and modifiers. Then I have other's stating that if ESRD related Hospice pays if NonESRD related we bill whomever we would normally bill as primary pays and that Medicare is not responsible for payment ever. We've tried calling Medicare and continue to get conflicting answers. All primary payors have denied claims stating Medicare should be billed for services.
Can someone please HELP! I need a reference to where I can locate this information. I'm being asked to provide proof of whatever the answer is.
The big question, WHO PAYS?
I have three scenarios...
1) Patient in hospice due to Dx1: Cardiovascular Disease Dx2: ESRD. Primary payor MHMO
2) Patient in hospice due to Dx1: Cardiovascular Disease Dx2: Unknown. Primary payor Commercial Insurance.
3) Patient in hospice due to ESRD. Primary payor MHMO
We've received conflicting answers. I have some stating that Medicare should be billed for ESRD with certain condition codes and modifiers. Then I have other's stating that if ESRD related Hospice pays if NonESRD related we bill whomever we would normally bill as primary pays and that Medicare is not responsible for payment ever. We've tried calling Medicare and continue to get conflicting answers. All primary payors have denied claims stating Medicare should be billed for services.
Can someone please HELP! I need a reference to where I can locate this information. I'm being asked to provide proof of whatever the answer is.