Guest guest Posted March 26, 2012 Report Share Posted March 26, 2012 Adolfo,I think –GV is the hospice modifier. It says you are seeing them not for the hospice issue Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of Adolfo TeranSent: Monday, March 26, 2012 10:02 AMTo: IMPSubject: hospice modifier code I have a patient that I am the PCP. She was admitted to the hospital and there she was advised to join hospice.I am having problems with Medicare to pay for my visits.I called the medicate about it, they said that we have to re-submit with a modifier.The hospice people are visiting her but still she visit me as her pcp.I have no clue what modifer they are talking about?any ideas? thanks, Adolfo Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 26, 2012 Report Share Posted March 26, 2012 Adolfo,This issue has come up on the listserv before. I believe that if you are providing care for someone that is enrolled in a hospice program that is related somehow to the reason for hospice, then that care will NOT be paid for by Medicare unless you are the attending physician for hospice care. Here is a quote from a Medicare publication:http://www.medicare.gov/publications/Pubs/pdf/02154.pdfYou must get hospice care from the hospice provider you chose. All care that you get for your terminal illness must be given by or arranged by the hospice team. You can’t get the same type of hospice care from a different provider, unless you change your hospice provider. However, you can still see your regular doctor if you’ve chosen him or her to be the attending medical professional who helps supervise your hospice care.If you are NOT the attending physician in charge of hospice care, then you may have trouble getting paid for services that may be seen as being related to why the patient is in hospice. Here is a link to an article describing how to use the GV and GW modifiers: http://www.aahcp.org/displaycommon.cfm?an=1 & subarticlenbr=17How do I bill for hospice?Effective April 1, 2002, CMS implemented the following changes in reporting services for hospice beneficiaries. All bills submitted to Medicare carriers for patients enrolled in a Medicare hospice program must contain one of the following modifiers:GW: Service not related to the hospice patient's terminal conditionGV: Attending physician not employed or paid under agreement by the hospice providerQ5: Service furnished by a substitute physician under a reciprocal billing arrangementQ6: Service furnished by a locum tenens physician SetoSouth Pasadena, CA Adolfo,I think –GV is the hospice modifier. It says you are seeing them not for the hospice issue Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of Adolfo TeranSent: Monday, March 26, 2012 10:02 AMTo: IMPSubject: hospice modifier code I have a patient that I am the PCP. She was admitted to the hospital and there she was advised to join hospice.I am having problems with Medicare to pay for my visits.I called the medicate about it, they said that we have to re-submit with a modifier.The hospice people are visiting her but still she visit me as her pcp.I have no clue what modifer they are talking about?any ideas? thanks, Adolfo Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 26, 2012 Report Share Posted March 26, 2012 This is true, you have to be the attending physician designated by Hospice. If they have someone else, you will not be paid. From: [ ] On Behalf Of Seto [glseto@...] Sent: Monday, March 26, 2012 10:19 AM To: Subject: Re: hospice modifier code Adolfo, This issue has come up on the listserv before. I believe that if you are providing care for someone that is enrolled in a hospice program that is related somehow to the reason for hospice, then that care will NOT be paid for by Medicare unless you are the attending physician for hospice care. Here is a quote from a Medicare publication: http://www.medicare.gov/publications/Pubs/pdf/02154.pdf You must get hospice care from the hospice provider you chose. All care that you get for your terminal illness must be given by or arranged by the hospice team. You can’t get the same type of hospice care from a different provider, unless you change your hospice provider. However, you can still see your regular doctor if you’ve chosen him or her to be the attending medical professional who helps supervise your hospice care. If you are NOT the attending physician in charge of hospice care, then you may have trouble getting paid for services that may be seen as being related to why the patient is in hospice. Here is a link to an article describing how to use the GV and GW modifiers: http://www.aahcp.org/displaycommon.cfm?an=1 & subarticlenbr=17 How do I bill for hospice? Effective April 1, 2002, CMS implemented the following changes in reporting services for hospice beneficiaries. All bills submitted to Medicare carriers for patients enrolled in a Medicare hospice program must contain one of the following modifiers: GW: Service not related to the hospice patient's terminal condition GV: Attending physician not employed or paid under agreement by the hospice provider Q5: Service furnished by a substitute physician under a reciprocal billing arrangement Q6: Service furnished by a locum tenens physician Seto South Pasadena, CA Adolfo, I think –GV is the hospice modifier. It says you are seeing them not for the hospice issue Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Adolfo Teran Sent: Monday, March 26, 2012 10:02 AM To: IMP Subject: hospice modifier code I have a patient that I am the PCP. She was admitted to the hospital and there she was advised to join hospice. I am having problems with Medicare to pay for my visits. I called the medicate about it, they said that we have to re-submit with a modifier. The hospice people are visiting her but still she visit me as her pcp. I have no clue what modifer they are talking about? any ideas? thanks, Adolfo Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 26, 2012 Report Share Posted March 26, 2012 So why is hospice telling me I can't be designated even tho' I was the primary? So patients are chosing not to do Hospice because they don't want to be changing doctors at the end of life. This includes not getting aid services. Families who do have Hospice with me on board (easier when it's Medicare Advantage) are furious that they get more from me than they do the Hospice folks. Right now they tolerate the Hospice director coming out every 2 months to recertify and I have gotten him to let me do the pain meds etc. but every time there's a new nurse they call him for orders instead of me. It's one more craziness of insurance over our patients humanity. To: " " < > Sent: Monday, March 26, 2012 12:56 PM Subject: RE: hospice modifier code This is true, you have to be the attending physician designated by Hospice. If they have someone else, you will not be paid. From: [ ] On Behalf Of Seto [glseto@...] Sent: Monday, March 26, 2012 10:19 AM To: Subject: Re: hospice modifier code Adolfo, This issue has come up on the listserv before. I believe that if you are providing care for someone that is enrolled in a hospice program that is related somehow to the reason for hospice, then that care will NOT be paid for by Medicare unless you are the attending physician for hospice care. Here is a quote from a Medicare publication: http://www.medicare.gov/publications/Pubs/pdf/02154.pdf You must get hospice care from the hospice provider you chose. All care that you get for your terminal illness must be given by or arranged by the hospice team. You can’t get the same type of hospice care from a different provider, unless you change your hospice provider. However, you can still see your regular doctor if you’ve chosen him or her to be the attending medical professional who helps supervise your hospice care. If you are NOT the attending physician in charge of hospice care, then you may have trouble getting paid for services that may be seen as being related to why the patient is in hospice. Here is a link to an article describing how to use the GV and GW modifiers: http://www.aahcp.org/displaycommon.cfm?an=1 & subarticlenbr=17 How do I bill for hospice? Effective April 1, 2002, CMS implemented the following changes in reporting services for hospice beneficiaries. All bills submitted to Medicare carriers for patients enrolled in a Medicare hospice program must contain one of the following modifiers: GW: Service not related to the hospice patient's terminal condition GV: Attending physician not employed or paid under agreement by the hospice provider Q5: Service furnished by a substitute physician under a reciprocal billing arrangement Q6: Service furnished by a locum tenens physician Seto South Pasadena, CA Adolfo, I think –GV is the hospice modifier. It says you are seeing them not for the hospice issue Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Adolfo Teran Sent: Monday, March 26, 2012 10:02 AM To: IMP Subject: hospice modifier code I have a patient that I am the PCP. She was admitted to the hospital and there she was advised to join hospice. I am having problems with Medicare to pay for my visits. I called the medicate about it, they said that we have to re-submit with a modifier. The hospice people are visiting her but still she visit me as her pcp. I have no clue what modifer they are talking about? any ideas? thanks, Adolfo Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 26, 2012 Report Share Posted March 26, 2012 That would be your hospice’s rules. You could ask to be a hospice physician. I have continued to see my patients on hospice. Especially for medical problems not related to the hospice diagnosis. Then I have to use the –GW modifier. I have also gotten paid when a patient on hospice “accidentally†got admitted to the hospital for an unrelated dx using that modifier. Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of MyriaSent: Monday, March 26, 2012 1:20 PMTo: Subject: Re: hospice modifier code So why is hospice telling me I can't be designated even tho' I was the primary? So patients are chosing not to do Hospice because they don't want to be changing doctors at the end of life. This includes not getting aid services. Families who do have Hospice with me on board (easier when it's Medicare Advantage) are furious that they get more from me than they do the Hospice folks. Right now they tolerate the Hospice director coming out every 2 months to recertify and I have gotten him to let me do the pain meds etc. but every time there's a new nurse they call him for orders instead of me. It's one more craziness of insurance over our patients humanity. To: " " < > Sent: Monday, March 26, 2012 12:56 PMSubject: RE: hospice modifier code This is true, you have to be the attending physician designated by Hospice. If they have someone else, you will not be paid. From: [ ] On Behalf Of Seto [glseto@...]Sent: Monday, March 26, 2012 10:19 AMTo: Subject: Re: hospice modifier code Adolfo,This issue has come up on the listserv before. I believe that if you are providing care for someone that is enrolled in a hospice program that is related somehow to the reason for hospice, then that care will NOT be paid for by Medicare unless you are the attending physician for hospice care. Here is a quote from a Medicare publication: http://www.medicare.gov/publications/Pubs/pdf/02154.pdfYou must get hospice care from the hospice provider you chose. All care that you get for your terminal illness must be given by or arranged by the hospice team. You can’t get the same type of hospice care from a different provider, unless you change your hospice provider. However, you can still see your regular doctor if you’ve chosen him or her to be the attending medical professional who helps supervise your hospice care. If you are NOT the attending physician in charge of hospice care, then you may have trouble getting paid for services that may be seen as being related to why the patient is in hospice. Here is a link to an article describing how to use the GV and GW modifiers: http://www.aahcp.org/displaycommon.cfm?an=1 & subarticlenbr=17How do I bill for hospice?Effective April 1, 2002, CMS implemented the following changes in reporting services for hospice beneficiaries. All bills submitted to Medicare carriers for patients enrolled in a Medicare hospice program must contain one of the following modifiers:GW: Service not related to the hospice patient's terminal conditionGV: Attending physician not employed or paid under agreement by the hospice providerQ5: Service furnished by a substitute physician under a reciprocal billing arrangementQ6: Service furnished by a locum tenens physician SetoSouth Pasadena, CA Adolfo,I think –GV is the hospice modifier. It says you are seeing them not for the hospice issue Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of Adolfo TeranSent: Monday, March 26, 2012 10:02 AMTo: IMPSubject: hospice modifier code I have a patient that I am the PCP. She was admitted to the hospital and there she was advised to join hospice.I am having problems with Medicare to pay for my visits.I called the medicate about it, they said that we have to re-submit with a modifier.The hospice people are visiting her but still she visit me as her pcp.I have no clue what modifer they are talking about?any ideas? thanks, Adolfo Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2012 Report Share Posted March 27, 2012 Myria, Our hospice program here (near Binghamton, NY) lets me be designated as the hospice physician, and their nurses call me directly for all orders. Maybe you should challenge your hospice on their statement. If that doesn't work, have the patient (or family) challenge them. Good luck!---Sharlene > >  > > > > > >Adolfo, > >I think †" GV is the hospice modifier. It says you are seeing them not for the hospice issue > > > > > >Kathy Saradarian, MD > >Branchville, NJ > >www.qualityfamilypractice.com > >Solo 4/03, Practicing since 9/90 > >Practice Partner 5/03 > >Low staffing > > > > > > > >From: [mailto: ] On Behalf Of Adolfo Teran > >Sent: Monday, March 26, 2012 10:02 AM > >To: IMP > >Subject: hospice modifier code > > > >I have a patient that I am the PCP. She was admitted to the hospital and there she was advised to join hospice. > >I am having problems with Medicare to pay for my visits. > >I called the medicate about it, they said that we have to re-submit with a modifier. > >The hospice people are visiting her but still she visit me as her pcp. > >I have no clue what modifer they are talking about? > >any ideas? > >thanks, Adolfo > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2012 Report Share Posted March 27, 2012 Myria,I recall when one of my patients signed up for hospice, the hospice personnel asked me if I wanted to be the attending physician or if I wanted to let their physician take over. I would think that if one hospice group insists that they take over your patient's care, you might be able to find another hospice group that would be happy to give you the option of remaining as the attending physician. Or is there only one hospice group in your area?According to this FAQ page from The Community Hospice (which appears to be located in your area):http://www.communityhospice.org/services/frequently-asked-questions/Q: Will I be able to continue with my own doctor?A: Yes. A Hospice medical director is available to consult with your doctor, and Hospice nurses wil work with your doctor on all aspects of care..And also this:http://www.communityhospice.org/for-care-providers/for-doctors/Even though your patient is on our Hospice program, you are still the lead physician. Your patient is still your patient. The medical decisions are still yours. Our medical directors are on-call consulting physicians to make sure you have access to every option available. SetoSouth Pasadena, CA Myria, Our hospice program here (near Binghamton, NY) lets me be designated as the hospice physician, and their nurses call me directly for all orders. Maybe you should challenge your hospice on their statement. If that doesn't work, have the patient (or family) challenge them. Good luck!---Sharlene > >  > > > > > >Adolfo, > >I think â€"GV is the hospice modifier. It says you are seeing them not for the hospice issue > > > > > >Kathy Saradarian, MD > >Branchville, NJ > >www.qualityfamilypractice.com > >Solo 4/03, Practicing since 9/90 > >Practice Partner 5/03 > >Low staffing > > > > > > > >From: [mailto: ] On Behalf Of Adolfo Teran > >Sent: Monday, March 26, 2012 10:02 AM > >To: IMP > >Subject: hospice modifier code > > > >I have a patient that I am the PCP. She was admitted to the hospital and there she was advised to join hospice. > >I am having problems with Medicare to pay for my visits. > >I called the medicate about it, they said that we have to re-submit with a modifier. > >The hospice people are visiting her but still she visit me as her pcp. > >I have no clue what modifer they are talking about? > >any ideas? > >thanks, Adolfo > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2012 Report Share Posted March 27, 2012 Thank you everyone. I have argued with them and I am covering my patients but they are not making it easier and my patients resent having to now see two doctors. It was purely by mistake that we found out that Hospice covers many of the medications saving one family over 300 a month in co-pays but it was by accident not that it was told to me or the family. I wish I could be certified as a Hospice provider if someone would teach me the criteria but I am told I would have to take a fellowship to be certified as a Hospice provider. I think the group in Rensealear is different than the one in Albany. Thanks I'm gonna check into that more. To: Sent: Monday, March 26, 2012 7:45 PM Subject: Re: hospice modifier code Myria,I recall when one of my patients signed up for hospice, the hospice personnel asked me if I wanted to be the attending physician or if I wanted to let their physician take over. I would think that if one hospice group insists that they take over your patient's care, you might be able to find another hospice group that would be happy to give you the option of remaining as the attending physician. Or is there only one hospice group in your area?According to this FAQ page from The Community Hospice (which appears to be located in your area):http://www.communityhospice.org/services/frequently-asked-questions/Q: Will I be able to continue with my own doctor?A: Yes. A Hospice medical director is available to consult with your doctor, and Hospice nurses wil work with your doctor on all aspects of care..And also this:http://www.communityhospice.org/for-care-providers/for-doctors/Even though your patient is on our Hospice program, you are still the lead physician. Your patient is still your patient. The medical decisions are still yours. Our medical directors are on-call consulting physicians to make sure you have access to every option available. SetoSouth Pasadena, CA Myria, Our hospice program here (near Binghamton, NY) lets me be designated as the hospice physician, and their nurses call me directly for all orders. Maybe you should challenge your hospice on their statement. If that doesn't work, have the patient (or family) challenge them. Good luck!---Sharlene > >  > > > > > >Adolfo, > >I think â€"GV is the hospice modifier. It says you are seeing them not for the hospice issue > > > > > >Kathy Saradarian, MD > >Branchville, NJ > >www.qualityfamilypractice.com > >Solo 4/03, Practicing since 9/90 > >Practice Partner 5/03 > >Low staffing > > > > > > > >From: [mailto: ] On Behalf Of Adolfo Teran > >Sent: Monday, March 26, 2012 10:02 AM > >To: IMP > >Subject: hospice modifier code > > > >I have a patient that I am the PCP. She was admitted to the hospital and there she was advised to join hospice. > >I am having problems with Medicare to pay for my visits. > >I called the medicate about it, they said that we have to re-submit with a modifier. > >The hospice people are visiting her but still she visit me as her pcp. > >I have no clue what modifer they are talking about? > >any ideas? > >thanks, Adolfo > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2012 Report Share Posted March 27, 2012 Call up the hospice doctor and talk to them,have youI got help that waySent from my iPod Thank you everyone. I have argued with them and I am covering my patients but they are not making it easier and my patients resent having to now see two doctors. It was purely by mistake that we found out that Hospice covers many of the medications saving one family over 300 a month in co-pays but it was by accident not that it was told to me or the family. I wish I could be certified as a Hospice provider if someone would teach me the criteria but I am told I would have to take a fellowship to be certified as a Hospice provider. I think the group in Rensealear is different than the one in Albany. Thanks I'm gonna check into that more. To: Sent: Monday, March 26, 2012 7:45 PM Subject: Re: hospice modifier code Myria,I recall when one of my patients signed up for hospice, the hospice personnel asked me if I wanted to be the attending physician or if I wanted to let their physician take over. I would think that if one hospice group insists that they take over your patient's care, you might be able to find another hospice group that would be happy to give you the option of remaining as the attending physician. Or is there only one hospice group in your area?According to this FAQ page from The Community Hospice (which appears to be located in your area):http://www.communityhospice.org/services/frequently-asked-questions/Q: Will I be able to continue with my own doctor?A: Yes. A Hospice medical director is available to consult with your doctor, and Hospice nurses wil work with your doctor on all aspects of care..And also this:http://www.communityhospice.org/for-care-providers/for-doctors/Even though your patient is on our Hospice program, you are still the lead physician. Your patient is still your patient. The medical decisions are still yours. Our medical directors are on-call consulting physicians to make sure you have access to every option available. SetoSouth Pasadena, CA Myria, Our hospice program here (near Binghamton, NY) lets me be designated as the hospice physician, and their nurses call me directly for all orders. Maybe you should challenge your hospice on their statement. If that doesn't work, have the patient (or family) challenge them. Good luck!---Sharlene > >  > > > > > >Adolfo, > >I think â€"GV is the hospice modifier. It says you are seeing them not for the hospice issue > > > > > >Kathy Saradarian, MD > >Branchville, NJ > >www.qualityfamilypractice.com > >Solo 4/03, Practicing since 9/90 > >Practice Partner 5/03 > >Low staffing > > > > > > > >From: [mailto: ] On Behalf Of Adolfo Teran > >Sent: Monday, March 26, 2012 10:02 AM > >To: IMP > >Subject: hospice modifier code > > > >I have a patient that I am the PCP. She was admitted to the hospital and there she was advised to join hospice. > >I am having problems with Medicare to pay for my visits. > >I called the medicate about it, they said that we have to re-submit with a modifier. > >The hospice people are visiting her but still she visit me as her pcp. > >I have no clue what modifer they are talking about? > >any ideas? > >thanks, Adolfo > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2012 Report Share Posted March 27, 2012 I didn't have to be " certified " as a hospice physician to care for my own patients on hospice. The program's medical director reviews the notes I send upon making the referral, to be sure the patient meets hospice criteria. I think it sounds like your hospice program is trying to force any physician payments to stay in-house, although I really don't know whether they get anything extra for that. Maybe a patient petition and letter to the local newspaper would be in order.---Sharlene---P.S. Why does everything have to be SO HARD??? > >> > >>  > >> > > >> > > >> >Adolfo, > >> >I think †" GV is the hospice modifier. It says you are seeing them not for the hospice issue > >> > > >> > > >> >Kathy Saradarian, MD > >> >Branchville, NJ > >> >www.qualityfamilypractice.com > >> >Solo 4/03, Practicing since 9/90 > >> >Practice Partner 5/03 > >> >Low staffing > >> > > >> > > >> > > >> >From: [mailto: ] On Behalf Of Adolfo Teran > >> >Sent: Monday, March 26, 2012 10:02 AM > >> >To: IMP > >> >Subject: hospice modifier code > >> > > >> >I have a patient that I am the PCP. She was admitted to the hospital and there she was advised to join hospice. > >> >I am having problems with Medicare to pay for my visits. > >> >I called the medicate about it, they said that we have to re-submit with a modifier. > >> >The hospice people are visiting her but still she visit me as her pcp. > >> >I have no clue what modifer they are talking about? > >> >any ideas? > >> >thanks, Adolfo > >> > > >> > > >> > > > > > Quote Link to comment Share on other sites More sharing options...
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