B9 Denial: Patient Enrolled in Hospice – Simple Explanation (With GV & GW Modifier Guide)
When working on medical billing denials, one common Medicare-related denial is:
✅ B9: Patient Enrolled in Hospice
This denial happens when a patient is actively enrolled in hospice and the claim is billed incorrectly (to Medicare Part B without proper modifiers or not billed to hospice).
In this guide, we will explain hospice eligibility, why the denial occurs, and how to resolve it in a simple way.
What is Hospice?
Hospice is a type of care for patients who have a terminal illness and are expected to live less than 6 months.
Hospice care focuses on:
• Comfort
• Pain relief
• Supportive care
❌ Not on curing the disease
When is a Patient Eligible for Hospice?
A patient becomes eligible for hospice in these situations.
1) Untreatable Disease
If a patient is diagnosed with a disease that cannot be treated and has a life expectancy of less than 6 months.
2) Treatment Refused Due to Risk
If a disease can be treated, but the treatment is life-threatening, and the patient refuses treatment, and life expectancy is less than 6 months.
What Happens After Choosing Hospice?
Once hospice is elected:
• The patient stops receiving treatment meant to cure or control the illness
• Only treatments for pain relief or comfort are allowed
• The beneficiary waives rights to Medicare Part B payments for hospice-related services
Billing Rules in Hospice Cases
Hospice billing has strict rules. When a patient is in hospice:
✅ Hospice-related services
These should usually be billed to the Hospice contractor, not directly to Medicare Part B (unless a modifier applies).
Important Modifiers in Hospice Billing
✅ GV Modifier (Hospice Related Service – Non-Hospice Physician)
Use GV when:
• Service is related to hospice condition
• Physician is an attending physician
• Physician is NOT employed/contracted by hospice
• Physician does NOT receive compensation from hospice
📌 Billing
Submit to Medicare Part B with GV modifier.
GW Modifier (Non-Hospice Related Service)
Use GW when:
• Service provided is NOT related to the hospice condition/diagnosis
📌 Billing
Submit to Medicare Part B with GW modifier.
Why Does B9 Denial Occur?
This denial occurs when:
1) Patient is in hospice and claim is not billed properly
• Claim not billed to hospice, and
• Claim not billed correctly to Medicare
2) Missing GV or GW Modifier
If the patient is enrolled in hospice and claim is billed to Medicare Part B, but:
❌ No GV modifier
❌ No GW modifier
➡️ The claim will deny.
✅ Solution
Append GV or GW modifier based on the service type.
How to Handle B9 Hospice Denial (Call Flow Process)
When you call insurance/Medicare and they say:
📌 “Claim denied as patient enrolled in hospice.”
Follow this step-by-step process.
Step 1: Ask for Denial Date
✅ “May I get the denial date?”
Step 2: Ask for Hospice Enrollment Period
✅ “May I have the hospice start date and end date?”
Step 3: Compare DOS with Hospice Dates
Check whether the Date of Service (DOS) falls within the hospice period.
Case A: DOS is NOT within hospice dates
Meaning: Patient was not in hospice on DOS.
✅ Request Reprocessing
“Could you please send the claim back for reprocessing since the patient was not enrolled in hospice on DOS?”
Then ask:
• “What is the TAT for reprocessing?”
• “May I get the claim number and call reference number?”
Case B: DOS IS within hospice dates
Meaning: Patient was in hospice on DOS.
✅ Ask for hospice details:
“Can I get the hospice information such as hospice name, NPI, mailing address, and policy ID?”
Then ask:
• “May I get the claim number and call reference number?”
Important Notes & Actions (Practical Billing Tips)
If DOS is outside hospice period
• Claim should be reprocessed
• Set follow-up based on rep’s TAT
If DOS is inside hospice period and hospice info is provided
• Update hospice as primary insurance
• Submit claim correctly
If rep gives only NPI number (No hospice details)
You can find hospice details using:
• NPPES website (to identify hospice name and mailing address)
• Medicare portal hospice tab (sometimes shows hospice NPI)
• Use SSN as policy ID if required (as per process/client approval)
If DOS is inside hospice period but NO hospice/Medicare details available
In some cases, the claim may be released to patient.
📌 Important
Always follow client instructions before assigning patient responsibility.
Special Note for Commercial Insurance Denials
If the denial is from commercial insurance and the patient is in hospice on DOS:
✅ Bill to:
• Hospice, or
• Medicare (if details available)
❌ Do NOT resubmit to commercial insurance again.
Conclusion
B9 hospice denial is very common and easy to resolve if billing rules are followed correctly.
✅ Always check hospice enrollment dates
✅ Compare DOS properly
✅ Use GV modifier for hospice-related services by non-hospice physicians
✅ Use GW modifier for non-hospice related services
✅ Bill to hospice when required
