HELP!!!! Hopice/Home health billing!

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2
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Roanoke, VA
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I work for a Home Health agency and have billed claims for a patient beginning on 5/3 the patient was discharged from Hospice on 5/2 the patient's insurance (Humana) has denied the claims stating "due to the fact that the patient was under hospice care." I have appealed the decision showing that the Hospice only billed 89 days and that he was no long receiving Hospice care he was "graduated" from their services and thus his home health claims should be billable. Today I received and email from Provider relations that states:

I reviewed the claims for dates of services 05/07/2016 – 05/12/2016 that have been denied for Hospice.

With the end date of 05/02/2016 Medicare would continue to be responsible for payment through the end of that month (05/31/2016). Humana would be responsible effective 06/01/2016. Therefore, the claims are denying correctly.

How is that possible???? Once the patient is no longer receiving Hospice wouldn't Humana coverage resume since the Hospice coverage is no longer elected by the patient?? I asked the provider services rep and she said "it's in the CMS guidelines." I asked where because I have read the guidelines looking for the answer with no luck! Can anyone please explain this to me??
 

honeybee

Networker
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54
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While im not extremely familar with hospice/HH billing I know that you can sometimes use the GW modifier to indicate that the services you provided were not related to the hospice DX. Not sure if that would apply in this case but I have had a few situation where I had to use this due to what appeared to be an overlap between the hospice episode and the physical therapy that we provided which caused our payment to be recouped and we rebilled and were able to be paid this way.
 
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