Patients suffering from terminal diseases and covered by Medicare with a life expectancy of six or less than six months can opt for hospice benefits. It allows for better care and alleviation of terminal conditions instead of traditional insurance perks.
The selection of Hospice benefits over standard Medicare coverage stands for comfort and quality of life in place of curative treatment. The hospice care stage is divided into two 90-day periods and unlimited 60-day periods. During this time, patients reserve the right to terminate the hospice care option at any time in favor of alternative care.
Medicare beneficiaries choosing hospice over Medicare benefits relinquish payments received for Medicare Part B services for terminal diseases. The condition doesn’t apply to services provided by an attending physician or a nurse practitioner. These services are customized to give them proper medical, emotional, and spiritual care without the Part B costs.
How Is Hospice Related with GV and GW Modifiers?
CMS has a standard procedure in place that allows healthcare providers to deliver exceptional healthcare services, facilitate billing and insurance-related matters and other aspects involved in Hospice treatment.
There are specific codes and modifiers to assist medical providers at every stage of the process. Today, we will discuss HCPCS Level II Medicare Hospice Modifiers – GV and GW. What are they, their significance, and how do they ensure accurate and proper reimbursement for Hospice services?
What Are Hospice Modifiers?
Modifiers like GV and GW play an integral role in medical billing and coding for patients with terminal illnesses. They help to document the Hospice care treatment and related services accurately. Here’s a quick look at some points that emphasize their significance.
- Increase medical billing accuracy
- Explain details of Hospice services
- Differentiate between multiple services
- Help in creating payable medical bills
- Provide efficiency in claim processing
- Ensure compliance with coding standards
All these points indicate the significance of these modifiers. Simply put, these important codes help to collect revenue against services provided by the doctor and also assist in maintaining compliance with regulatory guidelines.
Billing professionals and healthcare providers must also know the importance of these modifiers. The correct usage of these modifiers helps to streamline the billing, simplify reimbursement, and assist in providing excellent care to those with a life expectancy of six months or less.
How does Medicare Process GV and GW Modifiers in hospice medical billing?
GV Modifier
The use of this modifier indicates that the doctor attending and providing healthcare services to the patient isn’t employed or compensated by patient’s hospice provider. When such a situation arises where the patient is admitted to hospice and the doctor attending them isn’t paid by the hospice, they’ll get reimbursed by Medicare for the hospice service even if they aren’t associated with the hospice.
People responsible for billing matters must add the GV modifier to ensure swift and complete reimbursements. The use of the GV modifier points towards these outcomes:
- The services were delivered to a patient who had elected hospice care.
- Required services were delivered by the attending physician at the time of hospice enrollment.
- The modifier cannot be used in case a hospice-employed doctor provides the service.
- The modifier cannot be used in case a non-hospice employed doctor delivers the services but isn’t a patient attending doctor.
GW Modifier
Just like GV, the GW modifier plays a vital role in hospice medical billing. It helps to differentiate services delivered by the attending doctor that aren’t paid under the hospice arrangement. It helps to streamline the billing practices with accurate documentation while adhering to strict coding and billing compliance.
The use of GV modifier points towards these outcomes:
- Services provided to the hospice patient by an attending doctor
- Services aren’t covered under hospice benefits
- Helps maintain accuracy, precision, and compliance
- Assists in distinguishing non-hospice services
- Aids in reimbursement against services rendered
Common Mistakes Regarding GV and GW Modifiers Resulting in Claim Denials
While billing for hospice services, here are some important points to consider to stay safe from claim denials.
- Inaccurate usage of modifiers without having proper knowledge of coding and documentation may result in denials and delays.
- Using both the modifiers in the same claim will result in a straightaway denial.
- Using a GV modifier for terminal conditions may result in a denial.
- Likewise, the GW modifier for hospice care will be rejected.
- Not being able to maintain and show proper documentation will also result in the insurance company denying the claim.
Accurate Placing of The GW Modifier in Hospice Billing
When it comes to the correct placement of GW modifiers in hospice billing, the doctors or the medical billers must follow defined guidelines. The correct coding sequence on the claim demands mentioning the HCPCS code first and then the GW modifier. Only this way your claim will be approved for reimbursement.
We cannot neglect the importance of the GW modifier in hospice medical billing, especially when it comes to billing Medicare for services that fall outside the scope of hospice care for patient’s terminal illness.
People responsible for documentation must understand the proper usage of GW to ensure accuracy in coding. Also, mentioning the correct GW modifier after the appropriate HCPCS code in the claim form ensures timely approval and correct reimbursements.
Significance of GW Modifier in Medicare Hospice Billing
CMS requires maintaining compliance with its regulations and the GW modifier serves a vital role in doing so. It is also an essential tool for Medicare hospice patients. According to CMS, all hospice-related services must include a GV or GW modifier in the claim form.
It is mentioned to convey services that don’t fall under hospice care. Hence, it promises an accurate billing and documentation process. Healthcare providers must understand its significance and appropriate usage for Medicare hospice billing to meet the needs of CMS and maintain compliance with regulations.
How Does GW Modifier Help in Claiming Reimbursements?
From the sections above, it is evident that the GW modifier plays a crucial part in hospice billing, reimbursements, and billing outcomes. While its usage in documentation clearly indicates the services unrelated to hospice care.
Moreover, the GW modifier fulfills compliance with CMS guidelines for Medicare hospice patients. The appropriate usage of the GW modifier helps healthcare providers increase payment collections while billing for hospice billing.
Importance of Staying Updated with Coding Changes
If you’re a healthcare provider, someone related to the medical industry, or from the medical billing field, you know that medical coding is challenging. Moreover, coding, use of modifiers, and guidelines regarding these may change periodically.
Hence, it becomes important to stay updated with the changes and adapt to the latest and best practices to ensure correct documentation and proper reimbursement.
Here’s what is required:
- Arrange training sessions for your staff
- Help them stay updated with the usage guidelines
- Audit coding processes and documentation to make services better
- Stay informed about coding processes through trustworthy resources like CMS website
- Streamline communication between coding and clinical teams to abnegate all errors and ambiguities
Final words
Maintaining compliance and staying updated with the latest coding and insurance guidelines have always been essential in the medical billing world. Hospice billing is no different. It also mandates precise coding to indicate the quality of services delivered to those who require it the most.
GW modifiers are used to indicate services aimed at non-terminal ailments. Using it properly helps healthcare providers and medical billers to lower the number of denials. It also helps to reduce the turnaround time.
Staying vigilant and acquainted with the best practices, not only enhances the credibility of hospice providers but also helps them get proper reimbursements against services rendered.