Reason Code C7010

Description
Records show that the beneficiary has elected the Medicare hospice benefit and services billed as being related to the terminal diagnosis.

Resolution
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"
  • 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.

 

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. 

Contact Palmetto GBA JM Part A Medicare


Provider Contact Center: 855-696-0705

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