Reason Code C7010

Reason Code Narrative

THE EDITED INPATIENT OR OUTPATIENT CLAIM HAS FROM/THRU DATES THAT OVERLAP A HOSPICE ELECTION PERIOD AND IS NOT INDICATED AS TREATMENT OF A NON-TERMINAL CONDITION (CONDITION CODE '07') OR A MCCD/DMD NOTICE OF ELECTION (89A) FROM DATE OVERLAPS A HOSPICE ELECTION PERIOD.

Common Reason Code Errors

  • Common Working File shows a hospice election period open during claim dates of services (DOS).
  • A non-hospice related claim has been billed without the 07 (zero 7) condition code.
    • Condition code 07 indicates that, although beneficiary elected Medicare hospice benefit, services he/she received were for treatment or management of conditions not related to his/her hospice terminal illness.

Common Reason Code Corrections

  • If services being provided are related to the open CWF hospice election period, claim must be billed to hospice, not Medicare.
  • If services are not related to hospice election period append a 07 condition code to claim.

Help Avoid This Rejection

Provider Must Do Task Provider Action
  1. Verify if beneficiary is enrolled in (elected) Medicare hospice benefit
  • Access details via Health Insurance Query-A System (HIQA), online web application, Noridian Interaction Voice Response (IVR) system or HIPAA HETS 270/271 application
  1. Determine if beneficiary's services are related to his/her terminal illness or not
  • Openly communicate with beneficiary, his/her family and/or hospice agency as Medicare's CWF records do not contain hospice beneficiary's terminal illness diagnosis code(s)
  1. Bill hospice agency or traditional Medicare, as appropriate
  • Bill hospice agency for terminal illness related services
  • Bill Medicare for non-terminal illness related services
    • Must meet Medicare billing/coverage requirements
    • Include condition code 07 (zero 7) in Form Locator 18-28 of UB-04 claim or electronic equivalent field of 837I

 

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Last Updated Oct 31, 2019