Receiving and dealing with claim denials is an inevitable part of the medical billing process. However, what is important is how you minimize the rate of denials and take steps to manage them effectively.
At NeuraBill, we have decided to play our part in your journey of managing denials. Today, we will discuss denial code B9, where we will uncover the major reasons for receiving this code, what preventive measures you can take to avoid it, and, if unfortunately it occurs, what steps you must take to resolve the denial. So let’s begin our read!
B9 Denial Code – Description
Before we delve into the details, it’s essential to understand the description of this code and the message it conveys.
The B9 denial code appears when you bill services for a patient who is already enrolled in hospice care. It indicates that the billed services are related to the terminal condition of a patient and are already covered by the hospice.
Usually, the patients who are diagnosed with a terminal illness (incurable) or a life expectancy of less than six months are enrolled in hospice care. The billing for hospice care requires a separate approach under Medicare rules, and errors in billing, such as failing to use the appropriate modifiers or incorrect billing routes for hospice-related services, commonly trigger the B9 denial code.
What Causes the B9 Denial Code?
To deal with the B9 denial code, you must understand the reasons behind the appearance of this code. So let’s explore them first:
Billing for a Hospice Patient
The main reason for receiving a denial code B9 is that the patient is currently enrolled in hospice care. In such cases, the insurance payers do not cover the services that are part of the hospice program. In simple terms, you cannot separately bill a service provided for the treatment of a terminal illness because they are typically focused on end-of-life care rather than curative treatment.
Inaccurate/Missing Modifier
We have already discussed that you cannot separately bill services in hospice care. However, if you are providing services that are not directly related to their terminal illness, you can bill these services using modifiers like GV or GW in medical claims to clarify that such services or physician visits fall outside the patient’s hospice care plan. The insurance payer will use the B9 denial code to refuse payment if you attempt to bill these services without a modifier for a patient receiving hospice care.
Incomplete Documentation
Insurance payers also deny claims with the denial code B9 when they find it difficult to distinguish between services that are connected to and unconnected to a patient’s terminal disease in the absence of sufficient data. Hence, physicians and successful practices keep accurate records for each treatment to support its necessity.
How to Prevent B9 Denial Code?
The following information can help you prevent the denial code B9:
Communicate the Patient’s Hospice Enrollment
Always confirm your patient’s insurance coverage and hospice enrollment status before beginning any services. Furthermore, you must communicate with the patient’s insurance payer to verify if the patient is enrolled in a hospice program before filing their claim to Medicare Part B. This step will help you avoid confusion in billing and prevent the occurrence of the B9 denial code.
Use the Correct Modifiers
You must be extremely watchful for modifiers when filing claims for a patient receiving hospice care. The payer will be better able to comprehend the nature of services and adjust reimbursement with the aid of these modifiers. Depending on the circumstances, you can use these two modifiers:
- GV modifier: Used for services provided by a non-hospice attending physician in relation to the terminal illness.
- GW modifier: Ensures correct billing under Medicare Part B rather than hospice benefits for services unrelated to the terminal disease, e.g., dental care. It can be used by any clinician, including the non-hospice attending physician.
However, you must support these modifiers with appropriate documentation connected to claims to avoid the B9 denial code.
Stay Up-to-Date
The best way to avoid the B9 denial code is to stay aware. You must maintain communication with the insurance payer for the patients’ hospice care plan and stay up-to-date about their changing policies. Always cross-check the patient’s hospice details with the payer. This will reduce the possibility of denials by ensuring that hospice enrollment data is always accurate and up-to-date.
How to Resolve Denial Code B9?
The following are the steps you can take to resolve the denial code B9:
- Verify the main reason for the denial.
- Check if the denial was caused by incorrect service reporting or patient data.
- Ascertain whether the services are connected to the patient’s terminal condition.
- Make sure that the GV or GW modifiers are included in the claim.
- Include all relevant documentation to demonstrate that the services had nothing to do with hospice care.
- Resubmit the claim when all the details have been verified and the required modifiers have been applied.
Final Word
Hopefully, now with the help of this guide, you can prevent the denial code B9. But before we conclude this read, let’s recap. This denial code appears when the biller submits a claim for services rendered to a patient already enrolled in hospice care. As the services are part of end-of-life care and not curative treatment, the claim is denied. By implementing the preventive measures discussed above, you can completely avoid this denial code. Even if you have received this denial code, you can follow the resolution steps in our guide to resolve it. However, if you are facing significant issues with the B9 denial code, you can consider opting for NeuraBill’s expert denial management services. We train our staff regularly on the latest changes in each payer’s policies and on resolving denial codes.
