Surprises come in all shapes and sizes. Sometimes, they arrive as denial codes. Have you ever received a claim denial with a code you don’t fully understand? The B9 denial code is one such example. It has a simple description, yet it can be quite confusing for many.
Insurance companies often use this code when a healthcare provider fails to follow Medicare’s contractual obligations for hospice care. But what message does the B9 denial code convey, and can it be resolved or avoided? The good news is that you can easily tackle this denial code with the right approach. Read on to learn everything you need to know about this code.
B9 Denial Code – Description
Did you bill an insurance company for a hospice patient? If so, then you might receive the B9 denial code. This code clarifies that a patient is enrolled in a hospice program. Insurance companies use this Claim Adjustment Reason Code (CARC) when you violate Medicare’s rules for hospice care.
In short, the B9 denial code indicates that the billed services are related to the terminal condition of a patient and are already covered by hospice providers. Keep in mind that hospice care usually falls under Medicare Part A, which includes all aspects of inpatient care.
However, unrelated terminal conditions are typically covered under Medicare Part B. By understanding the difference between related and unrelated services, you can easily avoid the B9 denial code.
Reasons for Receiving The B9 Denial Code
The B9 denial code is quite common in hospice care billing. However, it is also as easily avoidable. You can steer clear of this code by understanding why it typically occurs.
Coverage Conflict (Billing for Hospice-Covered Services)
Coverage conflict is the primary reason for the B9 denial code. Payers immediately deny medical claims if the provided services are a part of the patient’s hospice program. Simply put, you cannot separately bill any service or treatment related to the terminal illness of a patient.
Missing Modifiers to Indicate Unrelated Services
Many patients in hospice care often receive services that are not directly related to their terminal illness. However, billing specialists must include GV or GW modifiers in medical claims to clarify that such services or doctor visits fall outside the patient’s hospice care plan. Otherwise, insurance companies can issue B9 denials.
Failure to Verify Hospice Enrollment
Insurance eligibility verification is quite crucial. If you fail to verify your patient’s hospice enrollment, you can receive the B9 denial code for submitting claims for services typically covered by their hospice provider.
Improper or Insufficient Documentation
Many services, usually high-cost or complex treatments, require medical justification. Therefore, successful practices and doctors maintain proper documentation for every treatment to justify their necessity.
Without proper evidence, it is quite challenging for payers to distinguish between services related and unrelated to the patient’s terminal illness. Hence, insurers may deny your claim with the B9 denial code.
What to Do For Denial Code B9 Resolution?
Don’t worry if you have already received a B9 denial. It might seem challenging to deal with this code. But what if we told you that you can resolve it effectively with the right approach? Follow our few simple tips to manage and resolve this denial code.
Review the Denial Details
The first step after receiving a B9 denial code is to review the details. Check the Explanation of Benefits (EOB) or the Electronic Remittance Advice (ERA) to confirm that hospice enrollment is the reason for your denial.
Verify Patient Eligibility
Next, confirm the patient’s hospice enrollment status. This will point you towards the appropriate measures. You can verify patient eligibility by reviewing their medical records. You must submit an appeal if the services were inaccurately flagged under hospice care.
Identify the Nature of the Provided Services
After that, you must determine whether the provided services are related or unrelated to the patient’s terminal illness. If the services are directly linked to their end-of-life condition, you should not bill them separately.
Check for Modifiers
After determining the nature of services, check whether your claim includes the appropriate modifier (GV or GW). Modifier GV is essential for clarifying that the services were provided by an attending physician – a provider not employed or contracted by the hospice.
On the other hand, modifier GW points towards non-hospice-related medical treatments (services unrelated to the patient’s terminal illness). If your original claim did not include any of these modifiers, include them and resubmit the claim.
Update & Resubmit the Claim
After performing all the checks, take the necessary steps to rework and resubmit the claim (if you can). Include all the supporting documentation to justify the medical necessity of the services.
File an Appeal
If you believe your claim was inaccurately denied, file a well-documented appeal. Explain why the services should be billed separately from a patient’s hospice care plan and provide all the supporting evidence to the payer.
Follow-up with the Insurance Company
Your job doesn’t end after resubmitting a claim or filing an appeal. Don’t forget to follow up with the insurance company after taking all the appropriate steps to address the B9 denial code. This step is crucial for preventing delays in reimbursements.
How to Prevent B9 Denial Code?
You should comply with Medicare’s hospice care guidelines to avoid B9 denials. Here is how you can do that!
Confirm Patient’s Hospice Enrollment Status
Before providing any service, check the patient’s insurance coverage and verify their hospice enrollment status. You can do this by contacting their insurance provider or viewing their medical records. This preventive step can help you effectively avoid the B9 denial code.
Understand Medicare’s Hospice Care Guidelines
Another key measure to avoiding the B9 denial code is to familiarize yourself with Medicare coverage for hospice care. Remember that services related to the patient’s end-of-life condition are typically covered under Medicare Part A and are usually billed by the hospice provider.
However, you can bill services unrelated to the patient’s terminal illness. They are typically covered under Medicare Part B.
Apply the Correct Modifiers
Modifiers can help you clarify the nature of provided services to payers. Use GV if you are an attending physician. Otherwise, use GW to indicate that the provided services have no link to the patient’s terminal condition.
Maintain Proper Documentation
Documentation can save you from denial code B9. Maintain proper records to justify the medical necessity of each service. This step will also help payers distinguish between related and unrelated services within the patient’s hospice care program.
Coordinate with the Hospice Provider
Communication is the key to avoiding billing confusion. Get in touch with the patient’s hospice provider to understand their hospice care plan. This will help you avoid the B9 denial code.
Train Your Billing Team
Provide frequent training to your billing staff to help them avoid common mistakes that lead to B9 denials. Conduct frequent workshops and training sessions to help them learn about hospice care guidelines and updates.
Establish A Proper Verification & Auditing Process
Want to avoid the B9 denial code completely in the future? Establish a proper insurance verification process to check every terminal patient’s hospice enrollment status. Moreover, double-check every claim multiple times before submission to verify whether it includes all the essential details, such as modifiers.
Bottom Line
We hope that by now, you fully understand the B9 denial code so you can avoid it in the future. To summarize, this code serves as a reminder to make sure that services related to a patient’s terminal illness are not billed separately from their hospice care plan.
You can avoid this denial code altogether by being proactive. This includes verifying the patient’s insurance coverage, using the appropriate modifiers, and providing all necessary supporting documentation. However, if the problem persists, invest in reliable denial management services to resolve this issue.
