A recent claims processing change is simplifying billing for DME suppliers servicing patients during hospice enrollment. For dates of service on or after September 7, 2020, the GW modifier effectively communicates that billed services are unrelated to the terminal diagnosis. The change eliminates the hassle and confusion of altering order diagnosis codes to properly demonstrate the separate need for DME equipment.
Chapter 11 section 40.2 of the Medicare Claim Processing Manual now reads:
“DME MACs shall make determinations of relatedness in the same way the A/B MACs Part B do today – based entirely on the presence of the GW modifier and not based on diagnosis coding. […] Claims that do not contain the GW modifier shall be denied.”
The Recovery Audit Contractor (RAC) made a stir in August 2018 when it proposed an automated recovery of DME claims without the GW modifier where the DME claim overlapped hospice enrollment. MiraVista pushed back, asserting DME MAC contractors had always paid or denied claims based on overlapping diagnoses and not the GW modifier. In fact, the Claim Processing Manual instructions made no mention of using the GW modifier with DME claims until the recent change. Subsequently, the RAC agreed to incorporate the overlapping diagnosis protocol into its audit parameters to avoid penalizing suppliers without the benefit of advance notice and education.
Ultimately, the processing modification is a welcome change that simplifies claim resolution for suppliers battling hospice denials.
SOURCE LINKS
https://cgsmedicare.com/articles/cope19389.pdf
https://cgsmedicare.com/jc/pubs/news/2020/11/cope19459.html
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c11.pdf
https://med.noridianmedicare.com/web/jddme/article-detail/-/view/2230715/gw-modifier-billing-reminder
https://www.miravistallc.com/blog/rac-collaboration-prevents-mass-recoupments
Chapter 11 section 40.2 of the Medicare Claim Processing Manual now reads:
“DME MACs shall make determinations of relatedness in the same way the A/B MACs Part B do today – based entirely on the presence of the GW modifier and not based on diagnosis coding. […] Claims that do not contain the GW modifier shall be denied.”
The Recovery Audit Contractor (RAC) made a stir in August 2018 when it proposed an automated recovery of DME claims without the GW modifier where the DME claim overlapped hospice enrollment. MiraVista pushed back, asserting DME MAC contractors had always paid or denied claims based on overlapping diagnoses and not the GW modifier. In fact, the Claim Processing Manual instructions made no mention of using the GW modifier with DME claims until the recent change. Subsequently, the RAC agreed to incorporate the overlapping diagnosis protocol into its audit parameters to avoid penalizing suppliers without the benefit of advance notice and education.
Ultimately, the processing modification is a welcome change that simplifies claim resolution for suppliers battling hospice denials.
SOURCE LINKS
https://cgsmedicare.com/articles/cope19389.pdf
https://cgsmedicare.com/jc/pubs/news/2020/11/cope19459.html
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c11.pdf
https://med.noridianmedicare.com/web/jddme/article-detail/-/view/2230715/gw-modifier-billing-reminder
https://www.miravistallc.com/blog/rac-collaboration-prevents-mass-recoupments
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