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Hospice Modifiers – Modifier GV and Modifier GW

hospice-modifiers-gv-and-gw

Assisting Physician Groups to Remain Profitable

When it comes to providing care for terminally ill patients, hospice services play a crucial role in ensuring comfort and quality of life. However, navigating the complexities of Medicare reimbursement for these services can be challenging for healthcare providers. Understanding hospice modifiers like Modifier GV and Modifier GW is essential for ensuring accurate billing and reimbursement. 

These modifiers are specifically designed for Medicare Part B services provided to hospice patients, allowing healthcare providers to bill for services rendered outside of the hospice benefit appropriately. Let’s explore the use of Modifier GV and Modifier GW and how they impact reimbursement for healthcare providers.

Understanding Hospice Modifiers?

Understanding hospice modifiers is essential for healthcare providers who offer services to Medicare beneficiaries receiving hospice care. When a Medicare beneficiary elects hospice coverage, they waive their rights to Medicare Part B payments for services related to the treatment and management of their terminal illness. 

However, there are exceptions to this rule, such as professional services provided by an attending physician or nurse practitioner. This is where modifiers for hospice, such as Modifier GV and Modifier GW, come into play. These modifiers help healthcare providers appropriately bill for Medicare Part B services provided to hospice patients outside of their hospice benefit. 

It’s important to note that the Notice of Election (NOE) should not be submitted with Part B claims to Palmetto GBA, as it is not required or reviewed for payment. Understanding these modifiers ensures accurate billing and reimbursement for services provided to hospice patients.

  • Hospice care must be elected by the individual, and certification of terminal illness must be completed by either the patient’s attending physician or the medical director/physician member of the Interdisciplinary Group (IDG).
  • Nurse practitioners acting as the attending physician are not permitted to certify or recertify terminal illnesses for hospice care.
  • Before hospice services can be provided, a comprehensive plan of care must be established.
  • Medicare covers only those services that are consistent with the established plan of care.
  • Certification of terminal illness relies on the clinical judgment of the attending physician or medical director regarding the expected course of the individual’s illness.
  • It’s essential to note that predicting life expectancy is not always precise and can vary.

Hospice Modifier GV

The GV modifier in medical billing plays a crucial role in ensuring accurate reimbursement for services provided to hospice patients. When appending the GV modifier, it indicates that the attending physician is not employed or paid under arrangement by the patient’s hospice provider. 

This modifier should be used when the services are related to the patient’s terminal condition or not paid under an arrangement by the patient’s hospice provider. Claims from the attending physician for services provided to hospice-enrolled patients can be submitted to Palmetto GBA with the Healthcare Common Procedure Coding System (HCPCS) modifier GV, irrespective of whether the care is related to the patient’s terminal illness. 

HCPCS modifier GV signifies that the service was rendered to a patient enrolled in a hospice and provided by a physician or nonphysician practitioner identified as the patient’s attending physician at the time of the patient’s enrollment in the hospice program. 

However, it’s important to note that if the service was provided by a physician employed by the hospice, the HCPCS modifier GV may not be submitted. Similarly, if the service was provided by a physician not employed by the hospice and the physician was not identified by the beneficiary as his or her attending physician, HCPCS modifier GV may not be submitted.

Hospice Modifier GW

The GW modifier in medical billing is essential for indicating that a service provided is unrelated to the patient’s terminal condition. When appending the GW modifier, it signifies that the service rendered is not related to the patient’s terminal condition. It’s crucial for all providers to submit this modifier when the service(s) provided are unrelated to the patient’s terminal condition. 

Claims for treatment of non-terminal conditions under Medicare Part A must include the GW modifier. Effective on or after January 5, 2019, any services submitted without the GW modifier under the outlined conditions will be denied. 

Therefore, accurate and timely use of the GW modifier is essential for ensuring proper reimbursement for non-terminal condition services provided to hospice patients.

GV VS GW Modifier

When it comes to billing for services provided to hospice patients, understanding the differences between the GV and GW modifiers is essential. Both modifiers play a crucial role in ensuring accurate reimbursement, but they serve different purposes. Here’s a comparison between the GV and GW modifiers:

ModifierPurposeExample
GVIndicates services related to the terminal condition of the patient and not paid under arrangement by the hospice providerServices provided by the attending physician unrelated to the hospice benefit, such as treatment for a common cold
GWIndicates services unrelated to the terminal condition of the patientServices provided for conditions not related to the patient’s terminal illness, such as treatment for a broken bone

Understanding when to use each modifier is crucial for ensuring proper billing and reimbursement for services provided to hospice patients.

Services Unrelated to the Terminal Condition

When a hospice patient requires medical services unrelated to their terminal condition, it’s essential to use the GW modifier for accurate billing and reimbursement. Any covered Medicare services that are not related to the treatment of the terminal condition for which hospice care was elected can be submitted to Palmetto GBA with the HCPCS modifier GW, indicating that the service is not related to the patient’s terminal condition. 

Here’s what you need to know about services unrelated to the terminal condition:

  • All covered Medicare services unrelated to the patient’s terminal condition during a hospice election period should be submitted to Palmetto GBA.
  • Use the HCPCS modifier GW to indicate that the service is not related to the patient’s terminal condition.
  • All providers must use the GW modifier when submitting services unrelated to the terminal condition for accurate billing and reimbursement.

Conclusion

Understanding hospice modifiers, specifically Modifier GV and Modifier GW is essential for healthcare providers to ensure accurate billing and reimbursement for services provided to hospice patients. Modifier GV indicates services related to the patient’s terminal condition, while Modifier GW indicates services unrelated to the terminal condition. 

By correctly applying these modifiers, healthcare providers can navigate the complexities of Medicare reimbursement with confidence, ensuring that hospice patients receive the care they need while maintaining compliance with Medicare billing guidelines.

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