Home Forums Discussions General Discussion Billing Question - Hospice

When I have a patient that is admitted to hospice, I have found I can no longer see them in the office and be paid for that visit, so we asked the hospice team to manage the issues. Since I"m an NP, it is the hospice medical director who has been signing all orders.

I now have a patient who is upset that I can no longer follow him. The hospice team will not deal with his blood pressure and they want me to see him in the office. In the past, this has resulted in non-payment. I've already spent about 2 hrs with the pt and the hospice team on the phone with this. The hospice team is insisting I can bill for my services by using a modifier "07". We have been unable to find that modifier in the list of Medicare modifiers. I do find a GW modifier.

Has anyone used this modifier? Were you able to bill as usual using it and were you paid. Other ideas?

Thanks!

You need to attach modifier -GW when you bill a hospice patient for non-hospice related diagnosis.

If you see a hospice patient for hospice-related diagnosis, you need to attach a modifier -GV and send this bill to hospice instead of Medicare.

Modifier 07 is used by non-physician providers (hospitals, HHA, PT, hospices, etc) to bill Medicare Fiscal Intermediaries for treating hospice patients with non-hospice related diagnoses.

Apricot,

Thanks for the response. I found this info, and thought I would share it with everyone.

50 - Billing and Payment for Services Unrelated to Terminal Illness
(Rev. 1, 10-01-03)
HSP-303.2, B3-4175.2, AB-02-015

http://www.cms.hhs.gov/manuals/downloads/clm104c11.pdf page 29

Any covered Medicare services not related to the treatment of the terminal condition for which hospice care was elected, and which are furnished during a hospice election period, may be billed by the rendering provider to the FI or carrier for non-hospice Medicare payment.

These services are coded with the GW modifier “service not related to the hospice patient’s terminal condition” when submitted to a carrier or with condition code 07 “Treatment of Non-terminal Condition for Hospice” when submitted to an FI. Contractors process services coded with the GW modifier and “07” condition code in the normal manner for coverage and payment determinations.

If warranted, contractors may conduct prepayment development or postpayment review to validate that services billed with the GW modifier or “07” condition code are not related to the patient’s terminal condition. See the related chapter of the Medicare Claims Processing Manual chapter for the type of service involved (i.e., Chapter 12 for physician type of services) for billing rules.

Barb,
I have a question an unrelated but in a similar vein type of question regarding putting in the billing codes in AC. Have you noticed or anyone else for that matter, that certain codes or modifiers can not be entered into the billing in AC? I have not tried this lately but before, when I tried to bill 100 units of Botox (I injected a patient with blepharospasms) it would not allow me to bill 100 units, I could bill less (99 or less). I tried to input two separate charges of 50 each but this did not work either. Any thoughts?
Francisco

Boy I don't know about the units since I've not had to bill that many units. However, I do know that I cannot add certain modifiers, specfically the QW which we have to use a lot.

I'm not sure why the restrictions. Since we currently are billing though office ally (though we are going to be outsourcing again), we have to change the HCFA on that end to do what we want.

Others have suggestions?

Barbara,
My "work around" this issue w/ Medicare is to simply not enter an ICD-9 code for their terminal illness, rather use their other non-hospice qualifying diagonses, i.e. HTN, DM, etc.

While perhaps technically incorrect, here is my viewpoint: I can talk about whatever I want behind closed doors w/ my patient, Medicare only needs to care about the diagnoses for which I am submitting claims. So I can document and code for the HTN, and discuss their cancer pain but simply not code for it. I would challenge Medicare to find out that I talked about their cancer pain, and if they are going to go after me.......fine, it's at least for a good cause.

don't forget to bill for the certification of hospice care, the re-certification, and the CPO (care plan oversight). This is in addition to the office visits.

Thanks Adam. As I said, I learned all this the hard way.

Jay - thanks for the reminder, however as an NP...I am not allowed to sign these certifications. Until there is literally an act of congress, NPs in this country cannot write home health orders/hospice order, sign the certifications/re-certifications or admit pts to these services. Nursing homes are also included in this.

Fortunately, I have a good working relationship with the hospice director in my area. And unfortunately, that does not carry over the the home health medical director. So when my patients need home health, they have to transfer care. They are not happy campers about this.

But I guess this is a whole 'nother can of worms.

Barbara

Thanks Jay.
I have billed for the CPO in the past.
I've found it rather laborious to document all the minutes spent on the non-face to face care. I recall the magic number is 30 minutes per month. You also must submit code G0182 for care provided to hospice patient. Most of the time, I spend less than 30minutes per month in answering nursing questions or signing the CPO forms.

However, a home visit is a reasonable way to make quite a lot more in revenue while doing something the patient finds something that's been largely lost, the house call.

Barb,
can you establish a relationship w/ any of the local family docs to simply sign your forms?

There's got to be someone left with an ounce of compassion?