By Jonathan 
Navigating the intricacies of medical billing can be a daunting task, especially in certain situations like hospice care. One letter switch while applying the modifier can cause a massive difference in the bill. Healthcare professionals can avoid billing issues and guarantee they are fairly rewarded for their services by knowing when and how to utilize these modifiers. This is where medical billing companies play a crucial role in ensuring that all billing processes are managed efficiently and accurately.
This article explores the main distinctions between the GV and GW modifiers and clarifies how they should be used when paying for hospice treatment.
Hospice Modifiers
Hospice refers to the specialized medical care given to those with a limited life expectancy, and the emphasis of the treatment is instead placed on managing symptoms and enhancing the quality of life. The primary focus of the care provided by the hospice team is the patient’s comfort, dignity, and physical relaxation.
Medical claims submitted to Medicare, the federal health insurance program, must include two character codes or modifiers. These modifiers help healthcare providers avoid claim denials by providing a reason for each service.
Part A of Medicare coverage includes hospice care. This section pays all doctors, nurses, and other healthcare workers working for hospice treatment; attending physicians who are not associated with hospice typically charge Medicare Part B for their services. Under this section, nonterminal services are also billed.
Medicare has developed GV and GW modifiers to help physicians distinguish between their hospice care services.
However, the proper use varies depending on the kind of services and the practitioner’s employment status.
GV Modifier for Medicare
A GV modifier is used during hospice treatment when the doctor participating in that patient’s care is not compensated by hospice or employed by hospice and providing services as an attending physician. The doctor’s dues will be reimbursed through Medicare for services related to hospice.
Let us suppose that a patient with skin cancer who is receiving hospice care goes to the dermatologist for a skin allergy they developed. The Hospice team overseeing the cancer therapy is unrelated to the dermatologist.
In this case, the dermatologist will charge Medicare with the GV modifier to show that the care was related to the patient’s hospice-covered terminal illness. While the dermatological procedure is unrelated to the patient’s cancer care received via Hospice, it still is an extension of the treatment.
While using the GV Modifier, here are some crucial things to remember:
- GV modifiers can only be added to claims where the doctors are not practicing hospice care, which means only non-hospice physicians will benefit. Doctors employed by hospice will be compensated by their contractors.
- Adding a GV modifier to the claim should be avoided if the doctor treating the patient in the hospice facility is not identified as the hospice employer.
- Even though the attending physician is not a Hospice employee, the Hospice contractor may only add a GV modifier if the patient qualifies for the hospice plans and services.
GW Modifier for Medicare
GW Modifier should be added to claims when the service provided to a hospice patient is unrelated to the patient’s terminal condition.
This should be applied by physicians, even if they are employed by hospice.
For example, a hospice patient with a terminal liver illness goes to an optometrist to get a standard eye examination. The optometrist would send the claim to Medicare using a GW modifier to indicate that the service is unrelated to the patient’s terminal illness.
When submitting claims to Medicare, the provider must apply the GW modifier to the CPT-10 code. When using GW Modifier, here are some essential pointers to remember:
- Physicians employed by Hospice will not have their GW modifiers added when they care for a specific illness. Hospice contractors will receive their claims. Medicare guidelines are the only way to interpret GW modifiers for ICD-10 codes.
- GW modifications will not be applied if a doctor is not listed as the patient’s attending physician.
- When a patient is enrolled in the hospice Program, and the doctor providing their care is not hired to treat the patient’s condition, the physicians would benefit by adding GW modifiers.
Difference Between GV and GW Modifier
Type of Service
Hospice care providers use both GV and GW modifiers to get paid for their services when filing claims. However, the factor that sets the two modifiers apart is whether or not the services relate to the patient’s terminal condition.
The GV modifier is used if the patient’s treatment is related to their terminal state. For example, if a patient with lung cancer sees a pulmonologist to address breathing problems, the doctor can file a medical claim using a GV modifier.
The GW modifier, on the other hand, indicates that the service rendered does not affect the patient’s terminal illness. For instance, if a patient with terminal lung cancer seeks medical attention for a broken arm after a fracture, a GW modifier will be applied to the relevant procedure code by the doctor while billing Medicare. This is because the service is entirely unrelated to the terminal illness.
Type of Healthcare Provider
The patient’s primary care physician uses a GV modifier. The attending physician generally has no connection to the hospice.
For example, to secure Medicare reimbursement, doctors who treat hospice patients but are not a part of any hospice team (oncologists, pulmonologists, dermatologists, and others) must use the GV modifier.
On the other hand, the GW modifier can be used by any healthcare provider who provides services to hospice patients, even those employed by hospice. For example, GW modifiers must be used for services rendered by physicians, specialists, or therapists working for hospice.
Bottomline
The hospice treatment has many complexities, so its billing process is complicated. This is why knowing the difference between the two most common modifiers used in hospice treatment claims is vital.
Due to the rising healthcare costs, programs like Medicare relieve patients of the burdens that hospice treatments might push. However, all the healthcare workers involved deserve fair and quick compensation. To ensure this, many providers outsource medical billing and coding services to manage these complexities effectively and streamline the billing process. After all, the end goal is to facilitate quality healthcare with an efficient billing system.