Scenario Based Quiz - Patient Enrolled in Hospice

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1. What are the correct hospice eligibility criteria from the below options? A patient is diagnosed with a disease that cannot be treated and has a life expectancy of less than 6 months
A patient is diagnosed with a disease that can be treated but due to life-threatening treatment, the patient denies taking the treatment and has a life expectancy of less than 6 months
The patient's age must be 65 or above
A patient has an end-stage renal disease
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2. When does a physician service get billed to hospice insurance? A. When a physician performs a hospice-related service and he/she is not an employee of the designated hospice or does not receive compensation from the hospice
B. When a physician performs a hospice-related service and he/she is employed/contracted by a hospice
C. Both A & B
D. None of the above
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3. When do we use the modifier 'GV'? When a physician performs a hospice-related service and he/she is not an employee of the designated hospice or does not receive compensation from the hospice and the same service is getting billed to commercial insurance
When a physician performs a hospice-related service and he/she is employed/contracted by hospice and the same service is getting billed to hospice insurance
When a physician performs a hospice-related service and he/she is employed/contracted by hospice and the same service is getting billed to Medicare Part B insurance
When a physician performs a hospice-related service and he/she is not an employee of the designated hospice or does not receive compensation from the hospice and the same service is getting billed to Medicare Part B insurance
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4. When do we use the modifier 'GW'? When a physician performs a service on a patient who is enrolled in a hospice but the service is not related to the hospice and the claim is getting billed to commercial insurance
When a physician performs a service on a patient who is enrolled in a hospice and the service is related to the hospice and the claim is getting billed to Medicare Part B insurance
When a physician performs a service on a patient who is enrolled in a hospice but the service is not related to the hospice and the claim is getting billed to Medicare Part B insurance
When a physician performs a service on a patient who is enrolled in a hospice and the service is related to the hospice and the claim is getting billed to commercial insurance
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5. What could be the valid reasons for the claim to be denied for denial code - B9? The patient is not enrolled in hospice and the claim is billed to Hospice or Medicare
The patient is enrolled in hospice and the claim is not billed to Hospice or Medicare
The patient is not enrolled in hospice and the claim is billed to Medicare Part B without GV or GW modifier
The patient is enrolled in hospice and the claim is billed to Medicare Part B without GV or GW modifier
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6. If you receive the status on call as the claim is denied as the patient enrolled in a hospice and the DOS does not lie between the hospice enrollment period then what will be your next valid questions? Could you please send the claim back for reprocessing since patient not enrolled in hospice on dos?
What is the TAT for reprocessing?
Can I get the hospice information such as hospice name, NPI, mailing address & policy ID?
All of the above
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7. If you receive the status on call as the claim is denied as the patient enrolled in a hospice and the DOS lies between the hospice enrollment period then what will be your next valid question? Could you please send the claim back for reprocessing since patient not enrolled in hospice on dos?
What is the TAT for reprocessing?
Can I get the hospice information such as hospice name, NPI, mailing address & policy ID?
None of the above
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8. If the claim is denied as the patient enrolled in a hospice and the DOS does not lie between the hospice enrollment period and the rep agrees to send the claim back for reprocessing then what will be your action? Resubmit the claim with the correct modifier
Set the follow-up for the TAT
Assign the claim to the coding team
None of the above
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9. If the claim is denied as the patient enrolled in a hospice and the DOS lies between the hospice enrollment period and the rep provides the hospice information then what will be your action? Resubmit the claim to same insurance
Release the claim to the patient
Assign the claim to the coding team
Submit the claim to hospice insurance after updating it as primary insurance
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10. If the claim is denied as the patient enrolled in a hospice and the DOS lies between the hospice enrollment period but the rep did not provide any information about hospice and there is no detail of Medicare available then what will be your action? Resubmit the claim with the proper modifier
Release the claim to the patient
Work as per the update
None of the above
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