Patient Enrolled in Hospice - JE Part B

Common Reasons for Message

• Patient is enrolled in Hospice on date of service
  • Medicare Part B only pays for physician services not related to Hospice condition and not paid under arrangement with Hospice entity
• Patient's Common Working File (CWF) has not been updated to show Hospice election has been revoked

Next Step

• Append Hospice modifier if appropriate
  • Modifier GV - Attending physician is not employed or paid under agreement by patient's Hospice provider
  • Modifier GW - Condition not related to patient's terminal condition
• Submit Appeal request - Items or services with this message have appeal rights
  • See Appeals webpage for instructions on how to submit a Reopening or Redetermination

Claim Submission Tips

• Verify patient's Hospice enrollment via Interactive Voice Response (IVR) or the Noridian Medicare Portal