E/M Coding Alert - 2007 Issue 36
READER QUESTIONS: Don't Forget Modifiers For Hospice Patients
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Article Overview
This reader Q&A addresses a common hospice billing problem: Medicare denials that arise when a patient has elected hospice care and the physician billing information is not aligned with hospice coordination requirements. It is aimed at physician practices, coders, and billing staff who work with hospice patients and need to understand the general reporting elements discussed in hospice-related claims handling. The article covers broad topics such as attending physician coordination, claim denial avoidance, place-of-service considerations, and Medicare billing workflow changes.
Why This Topic Matters
Hospice-related claims can be denied when billing information does not match the patient’s hospice status or the hospice’s reporting arrangements. Understanding the article’s scope helps billing staff identify whether it applies to their hospice coordination processes and claims submission workflow.
Article Sections
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Close relationship with hospice billers helps avoid denials
Introduces the hospice-related denial problem and discusses coordination between physician offices and hospice billing staff. The section also touches on claim submission issues and general Medicare billing concerns.
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Question
Presents the reader’s concern about repeated Medicare denials tied to hospice election status and delayed awareness of hospice care.
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Answer
Summarizes the response about hospice billing coordination, attending physician reporting, and general claim-processing considerations for physician services provided to hospice patients.
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Example
Provides a broad illustration of how hospice diagnosis information can affect physician billing and reimbursement handling.
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Tip
Offers practical advice on working with local hospices to reduce denials and improve billing communication.
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Make sure the hospice lists your doctor as the patient's attending physician
Discusses the importance of how the attending physician is recorded for hospice patients and the implications for claim processing.
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If your doctor isn't the attending physician
Addresses the alternate reporting situation when the physician is not the attending provider and notes that payment handling may differ.
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If you're using the correct modifiers and still not getting paid
Shifts to other claim elements that can affect payment, including billing location and service-type reporting for hospice-related services.
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Note
Describes a Medicare reporting change involving hospice and home health agency provider numbers on claims.
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As a last resort
Mentions an alternate billing workflow involving direct billing to the hospice rather than standard Medicare submission.
What You Will Learn
- How hospice election can affect physician claim submission and denial risk
- Why coordination with hospice billing staff matters for claims processing
- Which general claim elements may need review when hospice-related services are denied
- How billing workflow expectations may differ when a patient is under hospice care
Who Should Read This
- Physician office billers
- Medical coders
- Revenue cycle staff
- Practice managers
- Hospice billing staff
Codes Discussed
Modifiers Discussed
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