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Attention Home Health Agencies Receiving C7010 Billing Error

Over the past several months one of the top RTP reason codes for home health claims is C7010 – overlap with a hospice election period. The following information will help you avoid this reason code in the future and explain the appropriate steps to correct the billing errors.

When a RAP or claim is returned to the provider for reason code C7010, the Medicare claims processing system changes the original bill type to a 320 TOB.

If your HHA is providing services that are unrelated to a patient’s hospice care, it is important to submit the RAP claim for that billing period with a ‘07’ condition code. If the ‘07’ condition code is not submitted on the original billing, the system will RTP the bill for correction with reason code C7010. It is an important step during the correction process to update the TOB from the 320 that was assigned when the billing was returned to the provider back to the original TOB (322 for a RAP; 329 for a claim), as well as adding the ‘07’ condition code. 

If the TOB is not corrected to the original bill type, the bill will RTP again, or get suspended in a location that needs to be manually worked. If a RAP is suspended by the system, or RTP again for a different reason, this could result in a late RAP penalty on the final claim. In order to avoid or decrease the late RAP penalty, please be sure to follow these steps:

  • Check the CWF (via the IVR, NGSConnex, or HETS) 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
  • Submit your original RAP claim with the ‘07’ condition code for dates of service not related to hospice when within a hospice election period
  • Correct your RAP claim if returned to the provider for C7010 by adding the ‘07’ condition code and ensuring the TOB is changed from 320 back to the original bill type

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Posted 7/8/2021