Corporate

Hospice Election Requirements

Medicare Benefit Policy Manual (CMS Pub. 100-02), Ch. 9, §10, §20.2.1 and 40.1.3.1External PDF

To receive hospice services under the Medicare Hospice Benefit, the patient (or his/her authorized representative) must elect hospice care by signing an election statement. Each hospice designs and prints their own election statement.

As you develop your own Hospice election statements and certifications of terminal illness, please review the MLN Matters Special Edition Articles SE1631External PDF and SE1628External PDF for specific requirements you must include for valid documentation as well as example text.

The hospice's election statement must include the following items of information:

  • Identification of the particular hospice that will provide care to the patient;
  • The patient's or representative's (as applicable) acknowledgment that the patient has been given a full understanding of hospice care, particularly the palliative rather than curative nature of treatment;
  • The patient's or representative's acknowledgment that the patient understands that certain Medicare services are waived by the election;
  • The effective date of the election, which can be the first day of hospice care or a later date, but cannot be a retroactive date;
  • The patient's or representative's designated attending physician (if they have one). Include enough detail to clearly identify the attending physician. This may include, but is not limited to, the physician's full name, office address, or National Provider Identifier (NPI). (Effective for hospice elections on/after October 1, 2014.)
  • The patient's or representative's acknowledgement that the designated attending physician was their choice. (Effective for hospice elections on/after October 1, 2014.)
  • The signature of the patient or their representative.

NOTE: If the patient/representative wants to change their designated attending physician, they must file a signed statement with the hospice. The statement must include the following information:

  • Identification of the new attending physician. Include enough detail to clearly identify the new attending physician. This may include, but is not limited to, the physician's full name, office address, or the NPI;
  • The date the change is effective;
  • An acknowledgement that the change in attending physician was their choice;
  • The patient's or representative's signature; and
  • The date the statement was signed.

Any hospice election statement, or statement changing the designated attending physician, that is missing any one of the bulleted items above, is considered incomplete, and may result in the claim being denied.

Updated: 01.05.17


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