By recei Denial occurs when the patient is receiving end-of-life care through a Hospice organization. As the patient has coverage through hospice and only, they will be responsible to pay.
Common causes:
1. Patients who are receiving end-of-life care are reimbursed through hospice program as it is non curable generally and used for the patient who has a life expectancy of less than 6 months.
2. This occurs when a recipient has Medicare Part B only. Medicare does not cover hospice care when a recipient has part B only.
3. When the dates billed do not support the coverage period for hospice in our file.
4. Hospice-related services performed by the “attending physician” who is employed/contracted by hospice, should be submitted to the hospice contractor.
5. This denial also occurs when the patient is enrolled in hospice and the claim is billed to Medicare Part B without GV or GW modifier.
Ways to mitigate code 151 include:
1. GV Modifier: When patient was attended by physician who is not employed by hospice then provider must append GV modifier to the procedure code before submitting the claim to Medicare part B.
2. GW Modifier: Any services provided to a patient that is not related to a hospice condition should be submitted to Medicare Part B with a GW modifier.
3. Do not append GV modifier, when attending physician is employed by the hospice provider. Since those claims will be submitted to Hospice contractor for reimbursement.
4. Always call payer, if needed, to check the hospice enrollment period and if the claim denied incorrectly ask rep to send claim back for reprocessing. Ask rep about hospice details if the DOS lies between the hospice enrollment period.
5. Check Medicare website to find out hospice Information and take help from NPPES website to obtain the hospice name and mailing address.
6.Follow up with the payer on time to take action like submission of corrected claim or an appeal, initiate the necessary steps promptly.
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