Home Health Billing

Correcting and Avoiding Reason Code C7010: Overlap With a Hospice Election Period

Background

There are times when a patient may elect the hospice benefit while in a home health period. A hospice patient may receive home health services for a condition that is unrelated to the reason the patient elected the hospice benefit. When a patient receives home health services unrelated the terminal condition, the HHA should submit the RAP and final period of care claim with condition code 07.

Provider Action Steps

HHAs should verify eligibility for a patient prior to rendering any home health care by using the IVR system or by checking HETS for information in the CWF. If a beneficiary has elected the hospice benefit, this information is found on the CWF Hospice Periods page.

Example

Screenshot of the Health Insurance Query for Home Health (HIQH)

Providers may resubmit the home health RAP and/or claim with condition code '07' if the services provided are not related to hospice care.

Note: Prior to resubmitting the RAP and/or claim with the ‘07’ condition code, the type of bill must be changed from 320 (assigned when the claim RTP’d) back to the bill type originally submitted (i.e., 322 or 329) in order for it to process correctly.

How to Avoid This Reason Code

  • Check the CWF prior to rendering home health services to verify eligibility information.
  • Develop an internal process or checklist of systems/information that must be confirmed before submitting claims to Medicare.

Related Content

Revised 7/8/2021