Top Claim Submission Errors for All Providers: Error C7010
Reason for error: Beneficiary has elected the Medicare hospice benefit and services billed as being related to the terminal diagnosis.
Claim processing result: Reject
How to prevent/resolve:
- Verify with the beneficiary or their representative what health care services they are currently receiving at the time the service occurs.
- Review ELGA page 2 or ELGH page 8 to at the time of admission and prior to submitting claims to Medicare to determine whether the beneficiary has elected the hospice benefit and whether this election impacts your dates of service.
- Access the Checking Beneficiary Eligibility section of the FISS Reference Guide for more information about the ELGA/ELGH screens.
- If services are unrelated to the terminal diagnosis, ensure condition code “07” is entered in FL 18-28 of the CMS-1450 claim form.
- Condition code “07” can only be used when the services are unrelated to the terminal diagnosis; any other use of condition code “07” may be considered abusive.
Additional resource: Overlapping Services/Claims Frequently Asked Questions
Page last updated: September 23, 2008
