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Top Claim Submission Errors for Home Health Providers: Error C7010

Reason for error: Beneficiary has elected the Medicare hospice benefit and services billed as being related to the terminal diagnosis.

Claim processing result: Reject

How to prevent/resolve:

  • Verify with the beneficiary or their representative what health care services they are currently receiving at the time you admit them for Medicare home health care.
  • Review the beneficiary's Medicare eligibility information posted to Common Working File (CWF) at the time of admission and prior to submitting home health Requests for Anticipated Payment (RAPs) and final claims to Medicare to determine whether the beneficiary has elected the hospice benefit and whether this election impacts your dates of service.
    • See the CGS Checking Beneficiary Eligibility Web page for more information about the systems available to providers to check Medicare beneficiary eligibility information.
  • If services are unrelated to the terminal diagnosis, ensure condition code "07" is entered in FL 18-28 of the CMS-1450 claim form. Enter this in the first available COND CODES field on FISS Page 01.

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  • Condition code "07" can only be used when the services are unrelated to the terminal diagnosis; any other use of condition code "07" may be considered abusive.

For additional information regarding the impact of a hospice election for beneficiaries receiving home health services, please see the CGS Election of the Medicare Hospice Benefit While Receiving Home Health Services During an MA Plan Enrollment Period Web page.

Updated: 10.24.18

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