Action on enrolled Hospice Denial from Medicare

Medicare enrolled Hospice Denial and action

CO B9: Services are not covered because the patient is enrolled in a hospice.


Description in easy words: THESE SERVICES ARE DENIED BECAUSE THE PATIENT IS IN A HOSPICE

Action on Hospice Denial from Medicare

There are specific guidelines pertaining to Medicare hospice benefits. Certain Medicare coverage does not apply to a beneficiary that is enrolled in a hospice program.

To determine if a patient is enrolled in a hospice program, contact the IVR, from which the following data pertaining to the beneficiary can be obtained:

1: Hospice effective date
2: Hospice termination date (if applicable)
3: Servicing contractor number

Certain modifiers apply when the services/providers are not related to hospice:

GW Modifier: Services not related to the hospice patient’s terminal condition

GV Modifer: Attending physician not employed or paid under agreement by the patient’s hospice provider