Hospice: New requirement for physicians who certify patient eligibility

Physicians who certify patient eligibility for hospice service must enroll in Medicare or opt out effective for claims submitted on October 7 and after with dates of service June 3 or later.

For Medicare to pay for hospice services, the following physicians must enroll in Medicare or opt out:

• Hospice medical director or the physician member of the hospice interdisciplinary group who certifies the patient’s terminal condition
• Patient-designated attending physician (if they have one) who certifies the patient’s terminal condition

Note: CMS will deny hospice claims if the certifying physician isn’t in our PECOS hospice ordering and referring files.

If you’re currently enrolled or opted out, you don’t need to take action.

This new requirement:

• Only applies to Fee-for-Service Medicare
• Doesn’t prohibit the patient’s independent attending physician from treating them while in hospice and billing for these services under Part B
• Applies to all written or oral certifications under § 418.22(c) 
• Hospices can quickly verify a physician’s enrollment or opt-out status using the CMS ordering and referring data file, which lists all Medicare-enrolled and opted-out physicians

Additional information

Hospice certifying enrollment Q&A 

MLN Matters Article Hospice Claims Edits for Certifying Physicians