As previously discussed, hospice providers are required to have a hospice physician or nurse practitioner perform a face-to-face encounter with each hospice patient whose total length of stay is anticipated to reach the third benefit period.  This encounter must be performed no more than thirty days prior to the third benefit period recertification, and no more than thirty days prior to any subsequent recertification.

CMS has just released Transmital 2316 which updates the Claims Processing Manual to reflect the failure of a hospice to complete a timely face-to-face evaluation.  Such a failure will result in the beneficiary no longer being considered terminally ill for Medicare purposes due to lack of recertification.  As patients receiving a hospice benefit must be certified as terminally ill, no longer being considered terminally ill renders the patient ineligible for the Medicare hospice benefit.   (more…)