As a Medicare contractor, Palmetto GBA monitors submitted claims to identify common errors made by health care providers. We've noticed a large number of denials on claims submitted by laboratories due to hospice enrollment.
When patients elect hospice coverage, they waive all rights to Medicare Part B payments for services that are related to the treatment and management of his/her terminal illness. This is the case for all services except for professional services of the attending physician.
Any covered Medicare service not related to the treatment of the terminal condition for which hospice care was elected, and which is furnished during a hospice election period, may be submitted by the rendering provider for non-hospice payment. These services are submitted with HCPCS modifier GW: Service not related to the patient's terminal condition. All providers must submit this modifier when this condition applies.
It is important to investigate hospice coverage periods prior to submitting your claims. You can do this by calling the Provider Contact Center and speaking with a Customer Service Representative (CSR). They can be reached at (866) 332-7025 for Ohio/West Virginia providers or (888) 828-2092 and are available to assist you from 8:30 a.m. to 4:30 p.m., Monday through Friday except holidays.
References
- Access CMS guidelines related to hospice through the following links: