Just run eligibility for Humana and possible to get Medicare as primary. After confirmed that the billed Dx is not related to Hospice, append Mod GW and bill claim to Medicare as primary.
Okay its very very rare scenario happens. If happened, u need to do a analysis like really service related to Hospice or not. If Related, call Mcd & get hospice name , dates and bill to Hospice Care. If service not related to Hospice but provider is employee of Hospice, then MCD will give payments . If MCD still denied the same like Hospice, call and probe that service not related to Hospice and also PT doesn't have MEdicare, So your payer(Medicaid) only responsible for payments. So MCd should reprocess the claims towards payments. {👌Good Question}
if the claim denied as patient enrolled in hospice from Humana. How we gonna solve this? Is it like need to get the hospise date range, hospise info, if no proper hospise info need to send letter. Or if hospise info found we need to bill the claim to that payer?
Before letter send, check if pat has Medicare ✔️, if Medicare found, bill claim with GW MOD. If no MCR, only advantage (Humana), just check whether claim already billed with GW or not. If not bill with GW , wait and see for payment s. On analysis if you found that Dx billed to Hospice related truly and get call payer 🤳 and get HOSPICE details and bill claim to Hospice CARE with GV mod. 👍
Patient has Medicare advantage plan but PT enrolled in Hospice and got denial can we submit the claim to original Medicare otherwise add qw modifier and bill to the same ins
When I checked Medicare eligibility it shows Kaiser is primary during dos and also patient is in hospice during dos in this case can I bill to Kaiser or billed to Medicare with GW modifier?
Very useful for me thanks a lot
Thanks 🙏 for help
Welcome you Sanjeev Kumar.
What if humana denied the claim and provide B9 denial .so what should be action
Just run eligibility for Humana and possible to get Medicare as primary. After confirmed that the billed Dx is not related to Hospice, append Mod GW and bill claim to Medicare as primary.
Patient has only medicaid, get denied as patient is in hospice from medicaid,
Wht we have to do in this case?
No medicare for patient
Okay its very very rare scenario happens. If happened, u need to do a analysis like really service related to Hospice or not. If Related, call Mcd & get hospice name , dates and bill to Hospice Care. If service not related to Hospice but provider is employee of Hospice, then MCD will give payments . If MCD still denied the same like Hospice, call and probe that service not related to Hospice and also PT doesn't have MEdicare, So your payer(Medicaid) only responsible for payments. So MCd should reprocess the claims towards payments. {👌Good Question}
@@PKRVibesCareerGrowth Thank you so much really ur videos helpful to me
@@ssd12397 thank you.
Super bro
if the claim denied as patient enrolled in hospice from Humana. How we gonna solve this? Is it like need to get the hospise date range, hospise info, if no proper hospise info need to send letter. Or if hospise info found we need to bill the claim to that payer?
Before letter send, check if pat has Medicare ✔️, if Medicare found, bill claim with GW MOD.
If no MCR, only advantage (Humana), just check whether claim already billed with GW or not. If not bill with GW , wait and see for payment s.
On analysis if you found that Dx billed to Hospice related truly and get call payer 🤳 and get HOSPICE details and bill claim to Hospice CARE with GV mod. 👍
Patient has Medicare advantage plan but PT enrolled in Hospice and got denial can we submit the claim to original Medicare otherwise add qw modifier and bill to the same ins
Submit to Traditional Medicare along with GW modifier.
Thank you Sir
When I checked Medicare eligibility it shows Kaiser is primary during dos and also patient is in hospice during dos in this case can I bill to Kaiser or billed to Medicare with GW modifier?
Bill MCR with GW MOD
@@PKRVibesCareerGrowth thank you
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