Medicare Denial and Action - Enrolled in hospice

Action - Denied as - CO B9 Services are not covered because the patient is enrolled in a hospice.

Description: (THESE SERVICES ARE DENIED BECAUSE THE PATIENT IS IN A HOSPICE)
Tips / Resources
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 Interactive Voice Response Unit (IVR), from which the following data pertaining to the beneficiary can be obtained:

• Hospice effective date
• Hospice termination date (if applicable)
• Servicing contractor number

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

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

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

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