Hospice Determining Terminal Status

Medicare hospice coverage requires a physician certification that the beneficiary’s life expectancy is six months or less if the terminal illness runs its normal course. Eligibility is determined by documented non-reversible decline in clinical status (Part I) or by meeting Part II baseline impairment plus applicable disease-specific criteria; comorbidities and other documented clinical factors may also support coverage. Lack of appropriate documentation may result in denial, and patients who improve such that a six-month prognosis no longer applies should be discharged but may be re-enrolled if decline recurs.

"Medicare hospice is covered when a physician certifies the patient's prognosis is six months or less if the terminal illness runs its normal course."

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