OA-B9: Patient Enrolled in Hospice

What Does OA-B9 Mean?

When paired with Group Code OA, the hospice adjustment typically results from COB processing identifying the hospice as the responsible payer, or from retroactive hospice enrollment affecting a previously paid claim.

CARC B9 indicates the claim was denied because the patient is actively enrolled in a hospice program. When a patient elects hospice, most services related to the terminal illness become the hospice provider's responsibility. Other providers cannot separately bill Medicare or the payer for services that fall within the hospice benefit.

However, services unrelated to the terminal illness can still be billed separately — but they must be billed with the appropriate GW modifier (indicating the service is unrelated to the hospice diagnosis) and a diagnosis code that is not related to the terminal condition. Without this modifier, the payer's system automatically denies claims for patients with an active hospice election.

The most common cause of this denial is that the rendering provider was unaware the patient had enrolled in hospice and billed without the GW modifier. In other cases, the service may genuinely be related to the terminal diagnosis, in which case it should be billed through the hospice provider.

Common Causes

How to Resolve

1. Review COB details Determine if the hospice or another payer is responsible for the service.
2. Rebill with GW modifier if unrelated If the service is unrelated to the terminal illness, rebill with the GW modifier.
3. Coordinate billing with hospice If the service is related, coordinate billing through the hospice provider.

Common RARC Pairings

The RARC code tells you exactly what triggered the OA-B9:

How to Prevent OA-B9

• Verify hospice enrollment status with all payers during COB determination
• Coordinate billing with the hospice provider before submitting claims

Also Filed As

The same CARC B9 may appear with different Group Codes:

Related Denial Codes