B9 denial code description and corrective action

Patient enrolled in a hospice.

When a patient is diagnosed with a disease that cannot be treated, or with a disease that could be treated but the patient refuses treatment due to its life-threatening nature, and the patient has a life expectancy of less than six months, then the patient becomes eligible for hospice.
If hospice care is chosen, the patient receives only pain relief and comfort measures, not curative treatment for the disease.
In hospice billing, modifiers such as GV and GW are used.
GV: Used when the provider is not related to hospice but is providing services for a hospice patient.
GW: Used when the provider is related to hospice but is providing services that are not related to hospice care.
Hospice claims are billed to Medicare Part B.
This denial occurs when the claim is related to hospice care but is billed to a commercial payer.
It may also occur when hospice-related modifiers are not used.

First, we need to verify the status of the claim. This can be done by checking the status through the insurance web portal or by calling the payer.
The most important step is to determine whether the claim denial is valid or if the insurance has denied the claim by mistake.
Call the insurance company and confirm whether the date of service (DOS) falls within the hospice enrollment period. If the DOS is earlier than the hospice enrollment period, ask the representative to reprocess the claim. Be sure to document the claim number, representative’s name, and call reference number, and then follow up on the claim after the provided TAT.
If the DOS falls within the hospice period and the representative provides the hospice plan information, update the plan as primary and bill the claim.
We can also use the Medicare portal and the NPPES website to find hospice information.
If the representative does not provide any information, then check the documents or contact the member to obtain hospice information, and if found, submit the claim to hospice as primary.
If we are unable to obtain hospice information from any source, then we bill the claim to the member or proceed according to the SOPs of the practice and the client’s suggestion.
Commercial payer do not pay hospice claim.