How To Fix Denial Code B9 | Common Reasons, Next Steps & How To Avoid It
Denial Code B9 means that the patient is enrolled in a Hospice. Below you can find the description, common reasons for denial code B9, next steps, how to avoid it, and examples.
2. Description
Denial Code B9 is a specific denial code that indicates the patient is enrolled in a Hospice program. This means that the insurance company will not make payment for the billed service because the patient is receiving end-of-life care through a Hospice provider. In simpler terms, the claim is not payable because the patient’s care is being managed by the Hospice program.
2. Common Reasons
The most common reason for denial code B9 is that the patient is currently enrolled in a Hospice program. This typically occurs when a patient has a terminal illness and has chosen to receive palliative care rather than curative treatment. The insurance company will not cover services that are related to the patient’s terminal illness because they are being managed by the Hospice provider.
3. Next Steps
If you receive denial code B9, there are a few next steps you can take:
- Confirm Hospice Enrollment: First, verify that the patient is indeed enrolled in a Hospice program. This can be done by contacting the patient’s Hospice provider or checking their medical records. If the patient is enrolled in a Hospice program, you will need to accept that the claim will not be payable.
- Communicate with the Patient: It is important to have open and honest communication with the patient regarding their Hospice enrollment. Explain to them that the claim has been denied because they are receiving end-of-life care through the Hospice program. Provide them with any necessary information or resources to help them understand the situation.
- Explore Alternative Coverage: In some cases, there may be alternative coverage options available for services that are not related to the patient’s terminal illness. For example, if the patient requires treatment for a non-terminal condition, they may still be eligible for coverage under their insurance plan. Work with the patient and their Hospice provider to explore these options.
- Adjust Billing Practices: If you frequently encounter denial code B9, it may be necessary to adjust your billing practices. Ensure that you are properly screening patients for Hospice enrollment before providing services. This can help prevent unnecessary claim denials and save time and resources.
4. How To Avoid It
To avoid denial code B9 in the future, follow these steps:
- Screen Patients for Hospice Enrollment: Before providing any services, screen patients for Hospice enrollment. This can be done by asking them directly or checking their medical records. If a patient is enrolled in a Hospice program, be aware that their care will be managed by the Hospice provider and that claims related to their terminal illness will not be payable.
- Educate Staff: Ensure that your staff is educated about Hospice care and the implications it has on billing and reimbursement. Train them to properly identify patients who are enrolled in a Hospice program and to understand the limitations of coverage for these patients.
- Coordinate with Hospice Providers: Establish a good working relationship with local Hospice providers. Regularly communicate with them to ensure that you are aware of any patients who are enrolled in their program. This can help streamline the billing process and prevent claim denials.
5. Example Cases
Below are two examples of denial code B9:
- Example 1: A patient with a terminal illness is enrolled in a Hospice program. They receive a bill for a medical procedure related to their terminal illness, but the claim is denied with denial code B9. This is because the patient’s care is being managed by the Hospice provider and the insurance company will not cover services related to their terminal illness.
- Example 2: A patient is receiving Hospice care for a terminal illness. They visit a healthcare provider for an unrelated condition and submit a claim for reimbursement. The claim is denied with denial code B9 because the patient’s care is being managed by the Hospice program and the insurance company will not cover services unrelated to their terminal illness.
Source: Claim Adjustment Reason Codes
