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Back  RFI # 1503: 837P CRC Hospice Employee Ind.

Formal vs. Informal Help Informal Formal

Submitter

Julia Dunicheva

Description

Situational rule for CRC Hospice Employee Indicator states that it's required on Medicare claims and should not be send otherwise.
Does this rule takes into account only Destination payer (sent in loop 2010BB), or other payer information may be considered as well (sent in lop 2320)?
i.e. is it compliant to send CRC when 2000B\SBR09 is ZZ (not Medicare), but 23320\SBR09 is MB (Medicare)?

Response

The 005010X222A1 TR3 requires the Hospice Employee Indicator (2400 CRC) on all Medicare claims involving physician services to hospice patients. That requirement applies regardless of whether the destination payer is Medicare or the destination payer is a COB payer subsequent to Medicare. The Hospice Employee Indicator must be sent on claims going to Medicare for physician services to hospice patients, and that indicator must be carried forward to any subsequent COB claims going to another payer, whether provider submitted or payer to payer COB.
Submission 1/24/2012
Status Date 5/24/2012
Status F - Final
Primary References
Document 005010X222
Section2.4
Page376
Set ID837
Loop2400
Segment IDCRC
Industry NameHospice Employee Indicator