Medicare Part B Services Provided to Hospice Patients using the GV and GW HCPCS Modifiers eCBR

Published 02/23/2024

This electronic Comparative Billing Report (eCBR) focuses on providers that submit claims for beneficiaries receiving Part B services in a hospice setting.

eCBR information is one of the many tools used to assist individual providers in becoming proactive in addressing potential billing issues and performing internal audits to ensure compliance with Medicare guidelines.

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Overview of Medicare Part B Services provided to Hospice Patients with GV GW Modifiers
Medicare beneficiaries entitled to hospital insurance (Part A) who have terminal illnesses and a life expectancy of six months or less have the option of electing hospice benefits in lieu of standard Medicare coverage for treatment and management of their terminal condition. Hospice care is available for two 90-day periods and an unlimited number of 60-day periods during the remainder of the hospice patient’s lifetime; however, a beneficiary may voluntarily terminate his or her election period.

When hospice coverage is elected, the beneficiary waives all rights to Medicare Part B payments for services related to the treatment and management of his or her terminal illness during any period his or her hospice benefit election is in force, except for professional services of an attending physician, which may include a nurse practitioner.

Attending Physician
Only the direct professional services of an independent attending physician, who may be a nurse practitioner, may be submitted. The costs for services such as lab or X-rays are not to be included on the claim.

  • When the attending physician or nurse practitioner furnishes a terminal illness-related service that includes both a professional and technical component (e.g., X-rays), he or she submits the professional component of such services to the carrier and looks to the hospice for payment for the technical component.
  • Likewise, he or she would look to the hospice for payment for terminal illness related services furnished that have no professional component (e.g., clinical lab tests)

Documentation must comply with all legal and regulatory requirements applicable to Medicare claims.

CMS works to eliminate improper payments in the Medicare Program and protect the Medicare Trust Fund, as well as beneficiaries from medically unnecessary services or supplies and their associated costs. CMS calculates a national Medicare fee-for-service (FFS) improper payment rate and improper payment rates by claim type and publishes the review results annually.

Methods
The metrics reviewed in this eCBR are the proportion of billing for Medicare Part B claims billed with the GV GWHCPCS modifier analysis shows the portions of your billing at each level compared to your peers in Jurisdictions J and M.

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Example of eCBR
 
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