- Avoiding Reason Code 38200
- Correcting Reason Code 37253
- Reason Code 39929
- Influenza and Pneumonia Vaccinations in the Home Health and/or Hospice Setting
- Certification or Recertification of Medicare Covered Home Health Services
- Billing the Home Health Period of Care Claim - PDGM
- Disposable Negative Pressure Wound Therapy Services Under Home Health
- MLN Matters® 11855 Request for Anticipated Payment Submission Frequently Asked Questions
- Home Health Prospective Payment System Booklet
- Home Health Third Party Liability Demand Billing
- Home Health Demand Billing
- Counting 60-Day Episodes
- Notice of Admission Questions and Answers
- Home Health Patient-Driven Groupings Model (PDGM) FAQs
- Billing the Home Health Notice of Admission Electronically
- Billing the Home Health Notice of Admission via DDE
- Home Health Requests for Anticipated Payment
- Home Health Transfers
- Home Health Agency Transfer and Dispute Protocol
- Late Notice of Admission - The Exception Process
- Reporting Home Health Episodes with No Skilled Visits
- Telehealth Home Health Services: New G-Codes
- Reporting Site of Service Codes for Home Health Care
- PDGM Resources
- Billing G-Codes for Therapy and Skilled Nursing Services
- Correcting and Avoiding Reason Code 38157: Duplicate Request for Anticipated Payment
- Correcting and Avoiding Reason Code C7080: Inpatient Overlap
- Completing the Advance Beneficiary Notice for Home Health Agency Demand Claims
- Correcting and Avoiding Reason Code C7010: Overlap With a Hospice Election Period
- The Medicare Home Infusion Therapy Benefit and Home Health Agencies
- Home Health Therapy Billing
- Home Health Billing When a New MBI is Assigned
- Correcting and Avoiding Overlap Reason Codes
- 30-Day Home Health Therapy Reassessment Schedule
Correcting and Avoiding Reason Code C7010: Overlap With a Hospice Election Period
Table of Contents
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
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
- Information on home health coverage for a patient under hospice
- Information on billing as it specifically relates to home health
Revised 7/8/2021