Hospice Claims Edit Issue RC W7048
Hospice providers in Jurisdiction K and Jurisdiction 6
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
The October I/OCE was updated to correct this issue.