Working in a hospice is rather rewarding. However, healthcare practitioners need a little more than gratitude. They seek rightful payment for their services! Physicians and nurses employed at a hospice usually receive compensation from the government for providing services to terminally ill patients under their Medicare plans.
Usually, these professionals use GV and GW modifiers with the appropriate HCPCS codes to categorize hospice care services. Non-affiliated doctors use the GV modifiers to indicate the services related to a patient’s terminal illness. In contrast, all doctors use the GW modifier to address unrelated services.
Let’s explore the key differences between these two hospice modifiers!
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Hospice Modifiers
The federal health insurance program, Medicare, requires two character codes (modifiers) on medical claims. These modifiers explain why a healthcare provider has performed a specific service, helping them avoid claim denials.
Medicare’s coverage is divided into four parts. The federally administered healthcare program covers hospice care under part A. Hence, all the physicians and nurses employed by a hospice get their reimbursements from this part of Medicare. However, attending physicians (doctors not affiliated with the hospice) usually bill their services to Medicare Part B. Non-terminal services are also billed under this part.
The federal health insurance program has defined GV and GW modifiers to enable physicians to differentiate between their hospice care services. The appropriate usage, however, depends on the type of services and the practitioner’s employment status.
Let’s discuss these common hospice modifiers in detail.
GV Hospice Modifier for Medicare
In medical billing, the GV modifier is used by an attending doctor to specify that the service or treatment provided to a hospice patient is related to their terminal condition. This attending doctor is usually an outsider. In simple terms, he is not part of the hospice team.
To put things into perspective, let us give you an example. A hospice patient with terminal skin cancer develops a new skin allergy. He seeks treatment from a dermatologist who is not associated with the hospice. Since the new infection is related to the patient’s terminal condition, the dermatologist adds the GV modifier to the appropriate CPT code for medical claim submission.
GW Hospice Modifier for Medicare
In contrast, physicians use the GW modifier to address a non-terminal service they have provided to a hospice patient. Regardless of the employment status in the hospice, all doctors should use this modifier to claim reimbursements for unrelated treatments to the patient’s terminal diagnosis.
For example, a hospice patient with terminal lung cancer goes to a dentist for a root canal. Since the procedure is not associated with the patient’s terminal condition, the dentist bills Medicare with a GW modifier.
Difference Between GV and GW Modifier
Medicare modifiers, like GV and GW, are essential tools for hospice care providers. These hospice modifiers are crucial for accurate coding and reimbursements. Therefore, understanding their differences can help avoid unnecessary claim denials and rework.
Types of Services
Both GV and GW modifiers help hospice physicians claim reimbursements for their services. However, their usage depends on whether or not the services are connected to the patient’s terminal illness.
The GV modifier is used when the treatment is related to the patient’s terminal condition. For example, a lung cancer patient visits his pulmonologist to manage respiratory issues. The pulmonologist then submits a medical claim with a GV modifier.
On the other hand, the GW modifier specifies that the provided service is irrelevant to the patient’s terminal condition. For example, a terminally ill heart patient seeks medical treatment for eczema. In this case, the dermatologist bills Medicare using a GW modifier with the appropriate code.
Types of Providers
The GV modifier is used by a patient’s regular physician. The attending doctor is typically not associated with the hospice. For example, dermatologists, oncologists, pulmonologists, and more, who are not a part of any hospice team but provide services to hospice patients must use the GV modifier to obtain reimbursements from Medicare.
In contrast, any healthcare professional offering services to hospice patients can use the GW modifier, including those working at the hospice. For example, any doctor, specialist, or therapist employed by a hospice has to use a GW modifier for their services.
Bottom Line
Hospice is a holistic end-of-life facility, typically focusing on providing comfort to terminally ill patients. Government healthcare programs, such as Medicare and Medicaid, usually cover the costs of these facilities. The Medicare Hospice Benefit pays for everything related to the patient’s terminal illness, including equipment costs, medications, and more. As a result, hospice care providers can get reimbursements for their services.
We know how complex the billing process is for an average hospice provider. Therefore, we have clarified the two primary differences between hospice modifiers, GV and GW. Use the correct modifiers with the appropriate HCPCS codes to avoid unnecessary rework, payment delays, and financial loss.
