Wiki Hospice denial

dgarrett10

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How do I need to bill only Medicaid for unrelated diagnosis from Hospice, I have used GW as modifier and still get a denial from Medicaid. Thanks for any input.
 
We billed 99213-GW, we have uploaded denial from hospice. Medicaid denied stating covered by hospice.
 
Just checking to be sure you this was a typo... you sent it with a GV modifier correct not GW? Does the patient have Medicare? If so this would need to go to straight Medicare first. (regardless if it is a Medicare advantage plan)
 
When the member has a Medicare Advantage (MA) (Part C) policy and they have elected hospice enrollment, even though a claim may be for services unrelated to the hospice covered condition, the claim must still be submitted to traditional Medicare for consideration. That is where it is important to append the GV or GW modifier or on a UB-04 claim condition code 07 to indicate that the services rendered are not related to the hospice covered condition. Traditional Medicare will then consider the claim and if they agree that the submitted claim is unrelated to hospice covered condition, and if the patient is set up for Medicare Crossover claim processing showing the claim was denied by traditional Medicare. If the patient is not setup for Medicare crossover claims processing you can submit the claim to the MA plan with the MEOB showing Medicare's denial of the claim, which will then allow for the MA plan to consider the claim based on the plan benefits. Here is an article from Noridian Jurisdiction F - Part B regarding professional services provided during a hospice election period.

Professional Services during Hospice Election

Hopefully this helps you get your claims reconsidered correctly by traditional Medicare and the MA plan.
 
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