We're getting hospice claims denied by some of the Medicare Advantage Plans and need help! We've been told several different things and need clarification.
First case: We billed Sterling, but didn't know the patient was on hospice when we originally submitted the bill and they denied saying not covered because patient was enrolled in hospice. In this case, our physician was listed as the attending physician and the patient was seen for a non-hospice related illness. We thought we should bill Sterling for the services and add modifer GW to the 99213 code. Sterling says they won't pay for this and it should go to the patient's Medicare plan. Is this correct?
Second case: We billed Sterling and it was denied for the same reasons as the above case. The only difference here is the diagnosis was hospice related. The attending was our physician. Should this go to Sterling with the GV modifier or go to Medicare?
We would appreciate any help on this confusing subject!!!
First case: We billed Sterling, but didn't know the patient was on hospice when we originally submitted the bill and they denied saying not covered because patient was enrolled in hospice. In this case, our physician was listed as the attending physician and the patient was seen for a non-hospice related illness. We thought we should bill Sterling for the services and add modifer GW to the 99213 code. Sterling says they won't pay for this and it should go to the patient's Medicare plan. Is this correct?
Second case: We billed Sterling and it was denied for the same reasons as the above case. The only difference here is the diagnosis was hospice related. The attending was our physician. Should this go to Sterling with the GV modifier or go to Medicare?
We would appreciate any help on this confusing subject!!!