Hospice care focuses on enhancing the quality of life for terminally ill patients by providing comfort rather than curative treatment. In the complex world of medical billing, hospice-related services are billed under specific guidelines, including the use of modifiers. Among these, the GV modifier plays a crucial role in ensuring correct reimbursement for services provided by physicians who are not employed by the hospice but are still involved in treating the patient’s terminal condition.
Understanding the GV Modifier
In Medicare billing, the GV modifier is used when a patient enrolled in hospice receives care related to their terminal illness. But the attending physician is not affiliated with or paid by the hospice provider. This modifier ensures that services provided by external physicians. Such as specialists or primary care doctors not employed by the hospice, are accurately billed to Medicare Part B. Essentially, the GV modifier acts as a signal that the service is part of the patient’s care but is handled by an independent physician.
For instance, if a terminally ill patient in hospice with lung cancer develops complications that require a pulmonologist’s attention. The pulmonologist who is not employed by the hospice would bill Medicare using the GV modifier to indicate that the service. Is related to the patient’s terminal illness but provided independently.
Key Points for Correct GV Modifier Usage
- Non-Hospice Employment: The attending physician must not be employed by the hospice. If the physician is part of the hospice organization, the GV modifier cannot be applied.
- Terminal Condition: The service being billed must relate to the patient’s terminal condition. If the service is unrelated, the GW modifier would be more appropriate (more on this later).
- Medicare Part B: The GV modifier allows physicians to submit claims for services outside the hospice benefit covered by Medicare Part A. This ensures they are compensated for services that fall under their purview as the patient’s attending physician.
By ensuring these criteria are met, healthcare providers can avoid claim denials and streamline the reimbursement process.
When Should You Use the GV Modifier?
The modifier is particularly useful for cases where terminally ill patients require specialized care beyond what the hospice team provides. The most common use cases include:
- Consultations with Specialists: If a patient needs specialized treatment (e.g., dermatology for terminal skin cancer complications). The specialist is not a hospice employee. The GV modifier must be used for billing.
- General Physician Services: When a primary care physician continues to care for the patient after their enrollment in hospice and is not part of the hospice care team. The physician will use the GV modifier.
Difference Between GV and GW Modifiers
It’s important to differentiate between the GV modifier and the GW modifier, both of which apply to hospice billing:
- GV Modifier: Indicates that the attending physician is not employed by the hospice but provides care related to the terminal illness.
- GW Modifier: Used for services unrelated to the terminal condition, regardless of the physician’s employment status. For example, if a hospice patient with terminal lung cancer needs dental care, the dentist would bill Medicare with the GW modifier.
This distinction is essential because using the wrong modifier can lead to delays in payment, denials, or even non-compliance issues​.
Best Practices for Claim Submission with the GV Modifier
- Ensure Accurate Documentation: When submitting a claim, the HCPCS code for the specific service must be followed by the modifier. To indicate that the service was provided by a non-hospice-employed attending physician.
- Patient’s Hospice Status: Verify that the patient is enrolled in hospice care and that the service provided is directly related to the terminal illness.
- Coordination with Hospice: While the modifier applies to non-hospice physicians. It is important for these doctors to coordinate with the hospice team to ensure that the services provided align with the patient’s overall care plan. Misalignment can lead to claim issues and delays.
Frequently Asked Questions
What is the GV modifier in hospice billing?
The modifier is used in Medicare billing when a non-hospice-employed attending physician provides services related to a hospice patient’s terminal condition.
How is the GV modifier different from the GW modifier?
The modifier is used for services related to a patient’s terminal condition provided by a non-hospice-employed physician. While the GW modifier is for services unrelated to the terminal illness, regardless of the physician’s affiliation.
Who can use the GV modifier?
Any physician or specialist not employed by the hospice but treating a terminally ill patient for a condition related to the patient’s terminal diagnosis can use the modifier.
Can a hospice-employed physician use the GV modifier?
No, hospice-employed physicians cannot use the modifier. It is strictly for non-hospice-employed attending physicians.
What happens if the wrong modifier is used?
If the wrong modifier is applied, the claim could be denied, delayed, or require resubmission. Which could impact the reimbursement timeline.
Does the GV modifier apply to Medicare Part A or Part B?
The modifier is used for Medicare Part B services provided to hospice patients. As Part A covers most hospice-related services directly through the hospice provider.
Conclusion
Navigating the complexities of hospice billing can be challenging. But understanding the proper use of modifiers like GV is essential for accurate reimbursement. By correctly applying the GV modifier, attending physicians who are not affiliated with the hospice can ensure timely compensation for services related to a patient’s terminal illness. As Medicare continues to evolve, staying informed about these coding practices will help healthcare providers avoid billing issues.​
