Production Alert Details

Hospice Claims Edit Issue RC W7048

Date Reported:
Date Updated:
Provider Types Impacted:

Hospice providers in Jurisdiction K and Jurisdiction 6

Reason Code(s):
Claim Coding Impact:
I/OCE edit W7048 is incorrectly assigning on hospice claims for general inpatient care.

Description of Issue

National Government Services has noted an increase in hospice claims editing incorrectly for RC W7048 following the July 2023 system release. This is occurring for revenue codes 0250 (non-injectable prescription drugs), 0290 and/or 0294 (infusion DME and drugs), which do not require HCPCS codes.

National Government Services Action

Within 10 business days, NGS will suspend hospice claims that edit for RC W7048 to bypass the edit and allow the claims to process. This workaround will be in place until the October I/OCE is implemented for hospice claims, which will update the logic for RC W7048 to correct the issue.

Provider Action

Hospices who have had claims returned with RC W7048 since 7/1/2023, should return them for processing so they may bypass RC W7048. If a hospice had a claim(s) RTP prior to 7/1/2023, ensure the correct HCPCS codes were applied to the claim(s).

Proposed Resolution/Fix

Per CMS, the October I/OCE will be updated to correct this issue. Please continue to check the Production Alerts section of our website and future Email Updates.