How to Reduce Medicare Hospice Claim Denials

CGS Administrators

Did you know that the leading cause of Medicare hospice claim denials is lack of proper documentation of a terminal prognosis of 6 months or less? Between July and September 2022, this accounted for 59% of the denials. The good news is that you can easily avoid this with proper documentation.

Tips to Avoid Common Hospice Certification of Terminal Illness Documentation Errors

Medicare cannot make payments on claims with incorrect or missing dates, signatures, or identifying roles of the physician(s). Use the following tips to help avoid the most common types of documentation errors.

• Ensure the correct dates and signatures are included.

▪ Both the hospice medical director and attending physician (if applicable) need to sign the initial certification.
▪ Signatures need to be legible; if not, follow them with the printed or typed names.
▪ Ensure the physician(s) date their signatures.
▪ Do not predate physician certification signatures.

The Signature Guidelines tool offers additional information on signature requirements.

• Be sure to include a physician narrative and attestation statement.

▪ Include a brief narrative explaining clinical findings that support a life expectancy
of 6 months or less; see examples in this MLN Matters resource. 
▪ Include a statement attesting that the physician composed the narrative.
• State the dates of certification.
▪ Be sure to clearly state the dates the certification period encompasses.4

You can read up on all of the hospice certification/recertification of terminal illness requirements on CGS’ website and use the Hospice Documentation Checklist (see page 2) prior to submitting a claim.