Last Modified: 3/8/2010
Location: FL, PR, USVI
Business: Part A
The edited inpatient or outpatient claim has from/thru dates that overlap a hospice election period and is not indicated as treatment of a non-terminal condition (condition code '07').
OR
A Medicare Coordinated Care Demonstration (MCCD) notice of election (89a) from date overlaps a hospice election period
Resources/tips to avoid or correct this reject code
Always remember to check beneficiary eligibility prior to submitting the claims to your Medicare Administrative Contractor (MAC). There are two ways to obtain this information:
1. Direct data entry (DDE) users can pull the eligibility information by using the ELGA (eligibility A) or HIQA (health insurance query A) screens. Hospice information will show on page 2 for both the ELGA and HIQA screens.
2. Contact the interactive voice response (IVR) unit.
If you know the patient is in a hospice election period and you treated the patient for a non-terminal condition, add condition code 07 to the claim and resubmit.
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Source: FCSO Education Action Team
C7010