GW Modifier Hospice Billing: When & How to Use It Correctly

Hospice billing is a unique type of billing for hospice care patients. This department deals with patients who are near the death of their disease. Medicare has set a different set of code systems for these patients. HCPCS coding system is used for hospice billing. A modifier is an additional code that describes additional information about the services provided. GW modifier is a specific modifier that is used in this billing system.

Accurate medical billing is essential for ensuring smooth reimbursements and minimizing claim denials. At SysmD, we provide expert billing solutions tailored to various healthcare specialties, helping providers optimize their revenue cycle with precision and compliance.

In this blog post, we will provide a complete guide on GW modifier hospice billing. We will explain billing guidelines, Medicare recommendations, best practices, and recent updates for GW modifiers.

What is GW Modifier Hospice Billing?

The GW modifier shows that a service provided to a hospice-enrolled patient is not related to the terminal condition of the patient. For example, a patient has end-stage cancer and is admitted to the hospice care department, and later on he develops a urinary tract infection. The care and medication given for UTI will be indicated with the help of a GW modifier hospice.

Understanding the correct usage of modifiers like GW is crucial for hospice billing accuracy. Our in-depth guide on medical billing services explains how to apply the GW modifier effectively, ensuring compliance with Medicare guidelines and reducing financial setbacks.

When appended to a Healthcare Common Procedure Coding System (HCPCS) code, it signifies that the item or service is not associated with the patient’s terminal illness. Thus, Medicare suggests billing this service separately outside the hospice benefit.

GW vs. GV modifier:

In hospitals, another modifier is also commonly used for hospice billing. It is a GV modifier. You should know the main difference between these two modifiers so that you cannot use them interchangeably.

GV:

GV modifier is applicable when the attending physician is not paid by the hospice providers. It means that services are related to the patient’s terminal condition. This modifier indicates that the physician is the patient’s designated attending physician but is not affiliated with the hospice. Thus, the services provided to the patient are billed with hospice bills.

GW:

The use of GW modifier hospice billing is that it is applied to services that are not related to the patient’s terminal condition. Thus, the services provided to the patient are billed separately.

Uses of GW Modifier for Hospice Billing:

Do you want to reduce claim denials of hospice medical billing? Then, you should know the correct usage of the GW modifier for hospice billing. You should focus on the conditions where this modifier is applicable. For example:

Unrelated Medical Conditions:

When the medical illness is not related to the terminal condition of the patient. This is the main and the most common reason for using the GW modifier. For example, the patient has last-stage colorectal carcinoma and develops hyperbilirubinemia with this. So, you will mention the treatment expenses of hyperbilirubinemia with this modifier.

Emergency Situations:

When a hospice patient sustains an injury such as a fracture from a fall, the treatment for the injury should include the GW modifier. Thus, the emergency that is not related to the patient’s terminal illness will be included under hospice modifier GW.

Chronic Conditions:

When a patient has any chronic illness such as diabetes and hypertension, it is also not related to the terminal illness of the patient. That is why, GW is used as a modifier for this patient in hospice medical billing.

Billing Guidelines for Medicare hospice claims:

Do you want to know how to use the GW modifier in hospice claims? Do not worry, it is a simple and easy task, you can do it by following some billing guidelines from Medicare. Medicare Administrative Contractors (MACs) is an institute that provides billing guidelines for different departments including hospice. All hospitals should use these guidelines in their daily routine, otherwise, they will face complaint issues.

Important billing guidelines for hospice claims are as follows:

Modifier Usage:

You should GW modifier where it is necessary because Medicare processes these claims by itself. Otherwise, healthcare providers will face this financial burden. That is why, you should use GW modifier hospice to the appropriate HCPCS codes when services are unrelated to the patient’s terminal condition.

Documentation:

Complete and appropriate documentation is necessary for hospice medical billing. You should mention the unrelated condition of the patient in the documents with a correct modifier. Usually, a Hospice Election Statement Addendum is attached with the documents for the unrelated services in hospitals.

Claim Submission:

Correct claim submission is necessary for successful hospice billing. For example, if a biller does not mention the GW modifier for extra services of the patient, Medicare will reject the claim for payments. Further, you should also submit the claims according to the guidelines of the GW modifier for hospice billing.

HCPCS coding in Hospice Medical Billing:

HCPCS is a complete system for codes of the hospice department. That is why, accurate HCPCS coding is necessary for proper reimbursement:

Code Selection:

Every code is different for different services provided to the patient in the Hospice department. That is why, choose the accurate HCPCS codes that accurately represent the services provided.

Modifier Placement:

Usually, a modifier is written after the code of services. That is why, mention the GW modifier hospice directly after the HCPCS code. It will indicate the specific service is not related to the terminal condition.

Fee Schedule:

The fee schedule of Medicare for GW modifier claims changes regularly. That is why, you should be updated with Medicare Physician Fee Schedule (MPFS). It will help you understand the reimbursement rates for services billed with the GW modifier.

Best Practices for Hospice Modifier GW:

Do you want to maximize reimbursement rates in hospice medical billing? Then you should incorporate GW modifier hospice in the best way in claims and bills.

Some of the best practices for hospice modifier GW are as follows:

Detailed Records:

Medicare checks the complete record of patient data to reimburse hospice expenses. That is why, you should add the patient’s medical history, the nature of the unrelated condition, and the services provided in the records.

Hospice Election Statement Addendum:

As we discussed above, Hospice Election Statement Addendum is submitted with the claims. CMS stated is a compulsory condition for the submission of claims. That is why, prepare an up-to-date addendum that mentions the conditions and services unrelated to the terminal illness of the patient.

Recent Updates in GW Modifier Hospice Billing:

CMS and American Medicare suggest some updates in the usage of GW modifier:

• All the hospital organizations are required to have a valid addendum on file. This addendum will outline services unrelated to the terminal condition. This document will ensure transparency and support the appropriate use of the GW modifier.
• When a claim gets denied due to the omission of the GW modifier, hospice billers should verify the necessity of the modifier and resubmit the claim with the appropriate corrections.

Conclusion:

In conclusion, the correct usage of the GW modifier in hospice billing is necessary for streamlining billing tasks. The difference between GV and GW modifiers will highlight the usage of both modifiers and will ensure accurate billing. You should maintain detailed records to support the use of modifiers and facilitate claim approvals.

Further, you should review updates to hospice billing policies regularly. It will help you remain compliant with current regulations. Educate your staff with HCPCS codes to maximize revenues and reduce claim denials in hospice medical billing.