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Discharge or Revocation of Hospice Care

A discharge from hospice may occur when:

  • The beneficiary ceases to be eligible for the Medicare hospice benefit (i.e. patient no longer terminally ill, patient is unable to be recertified); or
  • The beneficiary moves out of the hospice's geographical service area, or
  • The beneficiary meets the hospice's internal policy regarding discharge for cause.

Upon discharge, any days remaining in the benefit period will be forfeited. The beneficiary may re-elect the hospice benefit period at any time, as long as coverage criteria are met.

A patient who is transferring from one hospice agency to another is not considered to be discharged for Medicare purposes. For additional information about hospice transfers, refer to the "Transferring Beneficiary From/To Another Hospice Agency" webpage.

A beneficiary may also choose to revoke the Medicare hospice benefit at any time. To revoke the benefit, the beneficiary must file a signed statement that he/she no longer wishes to receive Medicare coverage of hospice care for the time remaining in that election period. This statement must also include the date the revocation is effective. Any days remaining in the benefit period will be forfeited. The beneficiary may re-elect the hospice benefit at any time, as long as coverage criteria are met.

In addition to the usual claim information, your final claim must include the following to indicate a discharge or revocation:

TOB

(FISS Page 01)

Enter 8X1 or 8X4

Note: X = 1 (non-hospital based) or

2 (hospital based)

STMT DATES FROM

(FISS Page 01)

Enter the "from" date for the billing period.

STMT DATES TO

(FISS Page 01)

Enter the "to" date as the last payable day. This should be the date of discharge/revocation. If the beneficiary was discharged or revoked the hospice benefit effective 0429XX, enter 0429XX as the last payable day. The day of discharge (0429XX) is billed at the routine home care rate.

STAT

(FISS Page 01)

Enter '01' if the patient was discharged to home or self-care. Refer to the National Uniform Billing Committee (NUBC) Official UB-04 Data Specifications Manual at www.nubc.org for a list of all patient status codes.

COND CODES

(FISS Page 01)

Enter 'H2' if the patient was discharged by the hospice for cause, according to the hospice's documented policy. Discharge for cause includes cases where patient safety or hospice staff safety is compromised.

For dates of services on/after July 1, 2012Enter '52' if the patient was discharged due to unavailability or inability to receive hospice services. Examples include:

  • A patient who moved out of hospice's service area;
  • A patient who is receiving treatment for a condition unrelated to the terminal illness in a facility which the hospice does not have a contract with; or
  • A patient who is admitted to a VA owned and operated inpatient facility, and does not revoke hospice care.
See Change Request 7677 for additional information on condition code 52.

OCC CDS/DATE

(FISS Page 01)

For dates of service prior to January 1, 2012 – Occurrence code 42 is required if the beneficiary was discharged or revoked the hospice benefit as of the "TO" date on this claim. The date used with the OC 42 is the date of discharge or revocation.

For dates of service January 1, 2012, through June 30, 2012 – Occurrence code 42, is only required in the following situations:

  • Patient discharged as no longer terminally ill; or
  • Patient revokes their hospice election.

For all other situations, an occurrence code 42 is not reported. (See Change Request 7473.)

For dates of service on/after July 1, 2012 – Occurrence code 42 is only required when the patient revokes their hospice election. (See Change Request 7677.)

REMARKS

(FISS Page 01)

Enter the reason for discharge. Include your initials and the date the remark was entered.

Reference: Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 9, §20.2)

Medicare Claims Processing Manual (CMS Pub. 100-04, Ch. 11 §30.3)

Updated: 06.20.12


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