Billing and Coding: Hospice: Determining Terminal Status

Medicare requires a hospice physician or hospice nurse practitioner to perform a face-to-face encounter prior to the third benefit period recertification and each subsequent recertification (encounter may occur up to 30 days prior). Certifications and recertifications must include a physician-composed narrative attesting that clinical findings support a life expectancy of six months or less, be signed with benefit period dates, and be supported by sufficient clinical documentation (admission assessment, IDG notes, evidence of decline, test results, and level-of-care justification). Claims without valid ICD-10 codes, missing required signatures/fields, or lacking documentation meeting LCD standards may be returned or denied, and nurse practitioners may perform encounters but may not legally certify terminal illness.

"A hospice physician or hospice nurse practitioner must have a face-to-face encounter with each hospice patient prior to the patient’s third benefit period recertification and prior to every subsequ..."