Hospice

Hospices are seeing claims incorrectly return to provider (RTP) for reason code (RC) W7048.  CGS and Palmetto have added the issue to their Claims Processing Issues Log (CPIL) and there is no provider action required at this time.  The issue does not appear on the NGS Production Alerts, however, we do believe this is a systems wide issue.  We reached out to NGS and are awaiting a response. NGS updates its Production Alerts only after a certain number of inquiries on an issue, and it usually takes a little while longer to see the issue appear on their site.  Below are the details from the CGS and Palmetto CPIL.

Since the July 2023 System Release, Medicare has seen an increase in hospice claims editing for reason code (RC) W7048. This reason code states one or more visit revenue codes were reported on the claim without the required corresponding HCPCS code. RC W7048 has been firing incorrectly for revenue codes 0250 (non-injectable prescription drugs), 0290 and/or 0294 (infusion DME and drugs), which do not require HCPCS codes.

Visit revenue codes require a corresponding HCPCS code. More information on which revenue codes require HCPCS in claims may be found in section 30.3 - Data Required on the Institutional Claim to A/B MAC (HHH), of the Medicare Claims Processing Manual, Chapter 11, Processing Hospice Claims (PDF).

For example, if a hospice reports revenue code 055x (Skilled Nursing), HCPCS code G0299 or G0300 must be reported with it. Claims will be returned to the provider (RTP) with W7048 if they reported revenue code 055x without that HCPCS, regardless of the level of hospice care provided.