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Hospice billing and care plan oversite

  1. Default Hospice billing and care plan oversite
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    I work for a hemotology/oncology office and we have pts who are critically ill and need hospice or CPO. We have been billing 99375 for home and 99378 for hospice. We do not get payment from any commerical carrier for these codes. I am learning how to do this and want to make sure we are billing correctly. From what I understand if a pt is enrolled in hospice do they automatically enroll in Medicare and does it take over as their prmry carrier? If we are billing for CPO what code's will pay if we bill commercial carriers and does Medicare pay for this service what codes are used for CPO when it's Medicare G0181 with GV mod. only adn G0182 with GV for hospice. I just want to make sure our physicians are getting the most out of all they do and the rules of these codes are like chinese to me. Anyone who knows the best advide on how to bill these services correctly would be greatly appreciated. Thank you for your time.

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    Quote Originally Posted by MChappell159 View Post
    I work for a hemotology/oncology office and we have pts who are critically ill and need hospice or CPO. We have been billing 99375 for home and 99378 for hospice. We do not get payment from any commerical carrier for these codes. I am learning how to do this and want to make sure we are billing correctly. From what I understand if a pt is enrolled in hospice do they automatically enroll in Medicare and does it take over as their prmry carrier? If we are billing for CPO what code's will pay if we bill commercial carriers and does Medicare pay for this service what codes are used for CPO when it's Medicare G0181 with GV mod. only adn G0182 with GV for hospice. I just want to make sure our physicians are getting the most out of all they do and the rules of these codes are like chinese to me. Anyone who knows the best advide on how to bill these services correctly would be greatly appreciated. Thank you for your time.
    Only patients over age 65 are automatically on Medicare. Other patients with disabilities may also already have Medicare, but not everyone who goes into Hospice care qualifies for Medicare. Some might qualify for Medicaid services. Those with commercial insurance may have benefits for hospice care on their plan. Each of these will be a different billing situation.

    Is your provider the sole, or predominant, physician monitoring the patient's care? Only one physician may bill the CPO codes for a 30-day period. It would be more helpful to know exactly what kind of services your providers are doing in order to advise more accurately what codes would be best to use.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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