Hospice Certification / Recertification Requirements
In order for a patient to be eligible for the Medicare hospice benefit, the patient must be certified as being terminally ill. An individual is considered to be terminally ill if the medical prognosis is that the individual's life expectancy is 6 months or less if the illness runs its normal course. The certification/recertification is a critical piece of documentation necessary to ensure Medicare payment for the hospice services you provide.
NOTE: As you develop your own Hospice election statements and certifications of terminal illness, please review the MLN Matters Special Edition Articles SE1631 and SE1628 for specific requirements you must include for valid documentation as well as example text.
The hospice must obtain verbal or written certification of the terminal illness, no later than 2 calendar days (by the end of the third day) after the start of each benefit period (initial and subsequent). Initial certifications may be completed up to 15 days before hospice care is elected. Recertifications may be completed up to 15 days before the start of the next benefit period.
If written certification/recertification cannot be obtained within 2 calendar days, verbal certification must be obtained. The hospice must determine who may accept verbal certification from a physician in compliance with state and local law regulations.
In addition, the hospice must ensure the written certification/recertification is signed and dated prior to billing Medicare, or their claim(s) may be denied.
The certification should be based on the clinical judgment of the hospice medical director (or physician member of the interdisciplinary group (IDG), and the patient's attending physician, if he/she has one.
In addition to the initial certification for hospice, the patient must be recertified for each subsequent hospice benefit period.
The written certification/recertification must include:
Signatures for Initial Certifications:
For the first benefit period after election of the Medicare hospice benefit, the certification must be signed and dated by the:
Note: To sign the certification, the attending physician must be a doctor of medicine or osteopathy, and be identified by the beneficiary at the time he/she elects to receive hospice care as having the most significant role in the determination and delivery of the individual's medical care.
Signatures for Recertifications:
For the recertification (for subsequent hospice benefit periods), only the hospice medical director or the physician member of the IDG is required to sign and date the certification. The beneficiary's attending physician is not required to sign and date the recertification.
Medicare cannot make appropriate payment without correct dates, signatures and identifying roles of the physician(s). The following list identifies the common types of missing and inadequate information:
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