Again, this is an entry that does not necessarily pertain to persons within the mentally challenged community.  However, I spent much of the day on the phone trying to explain to doctors’ and therepists’ billing departments how to get paid for my husband’s recent injury.  On September 28, he fell and broke his leg and hip.  At that time he was a Hospice patient. 

Repeatedly Medicare has denied to pay his bills.  Naturally, if Medicare denys payment, our secondary insurance has also denied payment.  I began by calling my insurance company who told me that they could not pay the bills.  They told me that I needed to call Medicare.  Medicare said to call Hospice.  Hospice told me to call Medicare.  They said tell Medicare that even though my husband had not been released from Hospice, they should pay the bills because his injury was not related to his Hospice diagnoses. 

I called Medicare and explained.  They said that I needed to call every doctor, therepist and vendor to let them know that they needed to indicate that this was a duel diagnosis.  I began calling the 50 or so offices trying to explain to them what was needed.  The reactions ranged from “I can’t do that” to “I’ll try but I’m not sure how to do that.”

Finally, after almost all the calls, I received a return call from the first doctor I called.  His billing agent laughed.  “Trying to find out how to bill for Medicare when the patient is on Hospice was a real search project.  Finally, I found the key.  Tell everyone that they must put a ‘GW modifier.'”  This meant nothing to me but I began calling vendors again.  They seemed to understand my statement.

After a time, I began examining the bills that had been paid.  After each diagnosis, there is a number which I assume is the Medicare number for the diagnosis.  After this number a GW must be inserted.  It will look something like this.

  • 1.0 Initial hospital care (992223-GW)
  • 1.0 X-ray exam of hip (73510-26RTGW) professional charge

With this GW, each bill was paid.  A search and mystery but easily solved should you need to have this information.  As more and more people who are mentally challenged reach the elderly stage of life, vendors and doctors may need to know this infomration.