Hospice services refer to providing care to the patients suffering from a terminal illness. In addition, these services cover the social, physical, and emotional needs of the patients. Similarly, when the patients are enrolled in a Medicare certified hospice, there are certain modifiers which explain the hospice services. Likewise, when it comes to medical billing, GV and GW modifier elaborates the hospice services rendered to the patients. Let’s understand the differences between GV and GW hospice modifiers and their applications.
Processing of Hospice Modifiers
The patients who are terminally ill receive care in the hospice settings. In addition, the healthcare providers who offer services in the hospice settings are affiliated with the hospice facility. On the contrary, if the provider is not associated with the hospice setting, medical claims are sent to Medicare. So, the differences in the services are determined by the hospice modifiers GV and GW for reimbursement of hospice services.
When the healthcare provider offers services not related to the hospice diagnosis, the GW modifier in medical billing is used. Similarly, the provider or the billing staff needs to integrate GW at the time of claim submission. Likewise, to ensure an efficient end-to-end revenue cycle process for hospice services, it is essential to use modifiers correctly. Having said that, providers submitting hospice claims to Medicare get paid for their services by using modifiers. Keep in mind, using incorrect modifiers at the time of submitting a claim leads to claim denials.
When the healthcare provider offers services related to the hospice diagnosis, the GV modifier in medical billing is used. Additionally, the billing staff needs to submit appropriate claims with modifiers to get reimbursements for hospice services. Similarly, there should be distinction between GV and GW modifier at the time of claim submission. However, incorrect claims with wrong modifiers lead to delayed payments from Medicare. So, try to use the appropriate codes and modifiers dealing with the hospice services and prevent revenue losses.
Key Takeaways When Using Hospice Modifiers
- For physicians who do not offer hospice services, GV modifier is helpful.
- The physicians hired by the hospice should submit claims to the hospice contractor.
- If the physician is not affiliated with the hospice setting, avoid the GV modifier in billing.
- Modifier GW will not be used when the provider is not working as an attending physician.
- When the patient is beneficiary of the hospice program and the physician is not employed for the patient’s condition, modifier GW is used.
Claim submissions for hospice services with modifiers is essential to get paid for services. Also, various scenarios determine whether to use GV or GW modifier for billing. Similarly, a systematic approach is required to ensure appropriate billing for hospice services. In addition, providers and billing staff need to make sure that codes and modifiers are used correctly according to the procedures. As a result, it helps to get complete and timely reimbursements from insurance payers. So, implement a clean claim submission approach to avoid revenue losses and improve financial performance when offering hospice services.