For practice managers, healthcare providers, and owners, understanding the correct use of Hospice Billing Modifiers GW and GV is absolutely essential. These critical modifiers distinguish between services related and those unrelated to hospice care. Proper application ensures accurate Medicare billing, consistent compliance, and appropriate reimbursement. Failure to use them correctly leads to automatic claim denials.
GW Modifier: Services Unrelated to Hospice Care
The GW Modifier signals that a service or condition is completely unrelated to the patient’s terminal illness. This modifier proves crucial because Medicare will only pay for covered services when they fall outside the hospice’s scope of care.
- When to Use: Append modifier GW to claims for conditions that have no connection to the terminal diagnosis.
- Example: A hospice patient with terminal lung cancer receives treatment for uncontrolled diabetes. Since diabetes management is unrelated to the terminal diagnosis, you must append modifier GW to all diabetes-related claims.
- Key Requirement: Documentation must clearly show the unrelated nature of the service. Crucially, providers outside of the hospice agency bill these services directly to Medicare; the hospice provider cannot bill them.
GV Modifier: Attending Physician Services
The GV Modifier is used exclusively for physician services provided by the patient’s Attending Physician when that physician is not employed by or contracted with the hospice.
- When to Use: Utilize modifier GV when the attending physician provides services independently of the hospice’s daily care plan.
- Example: A patient’s long-time primary care physician continues managing chronic hypertension during hospice care. Because the physician is not hospice-affiliated, you must use modifier GV on those claims.
- Key Requirement: The physician must be formally identified as the attending physician in the patient’s hospice records. Consequently, these services must be reasonable and necessary for patient care, and the hospice agency cannot bill for them.
Conclusion
Mastering Hospice Billing Modifiers GW and GV is mandatory for revenue integrity. In summary, GW distinguishes unrelated services, and GV identifies independent attending physician care, ensuring proper Medicare payment.