Wiki hospice billing

[melissametz]

I am trying to bill a claim for a patient who has signed up with hospice. We saw her in the hospital. Medicare has denied the claim with the reason of: PR-B9 : Services not covered because the patient is enrolled in a Hospice.

Do I have to bill hospice patients different then regular patients? Thanks for any help!

 

[RebeccaWoodward*]

Was the condition related to her hospice condition? If not, you need to bill with a modifier.

GW modifier “service not related to the hospice patient's terminal condition.”


https://www.cms.gov/manuals/downloads/clm104c11.pdf

Section 50

 

[jgf-CPC]

Rebecca is correct but if the Dx IS related to the hospice stay than you have to bill the hospice that the patient is assigned to.

 

[melissametz]

Thank you both for your help!