OIG Hospice Report

Written by Lisa Eick RN

CMS recently re-published an article regarding the OIG report from September 2016 that found more than one third of Hospice election statements and certification of terminal illness documents were found to be non-compliant. The sample included only General Inpatient stays (GIP), however the article is a great reminder for all Hospice providers to monitor these documents to ensure they include all required elements. The takeaways from the OIG report include:

Election Statements      

Periodically review the election statements to ensure all required elements are included in the statement. This is of particular importance for agencies who have made changes to the election statement to meet compliance requirements. It is not uncommon, for old forms to find their way out of the filing cabinet (electronic or otherwise). As a reminder the following are the election statement requirements.

Election Statements must include the following:

  • The name of the Hospice providing care to the patient.
  • An acknowledgement that the patient (or authorized representative) has been provided a detailed explanation of hospice care. This must include a clear description of the nature of hospice care and treatment as palliative and not curative in nature.
  • An acknowledgement that certain other Medicare services are waived (not covered) while on hospice care.
  • Election date: Must not be prior to the date of election. May be the first day of hospice care or later.
  • Designated attending physician must be clearly identified by full name, office address or the National Provided Identifier (NPI).
  • An acknowledgement the attending physician was their choice.
  • The signature of the patient (or authorized representative.

An election statement missing any one of the required criteria is incomplete and may result in a Medicare denial.


Physician Certifications

Develop a system of routine audits of physician certification forms to ensure all required elements are completed and meet Medicare requirements for a compliant certification. By developing systems and processes for auditing the physician certification forms, agencies may identify areas of weakness and opportunities for educating providers on the Medicare requirements. As a reminder the following are the requirements for the physician certification form.

  • Written certification must include
    • A statement that the patient has a life expectancy of 6 months or less if the terminal illness
    • A narrative from the certifying physician which includes clinical documentation that supports the patient has a terminal diagnosis.
      • The narrative can be part of the certification form or an addendum.
      • If part of the form it must be located above the physician signature.
      • If an addendum the physician must sign following the narrative.
      • Must include an attestation statement above the physician signature and date stating he/she completed the narrative based on review of the clinical findings in the patient medical record or upon examination of the patient.
      • Benefit period dates.
      • Recertification for the third benefit period must include a narrative explaining the findings of a face to face visit that continues to support a life expectancy of less than six months. The narrative must include the date of the visit and an attestation that he/she performed the visit. If the visit was done by a nurse practitioner the must be an attestation the results of the visit were provided to the physician.
    • Signature requirements
      • Handwritten signature, must have a hand written date
      • Electronic signatures and date
      • Stamped signature are not acceptable.
      • https://www.cgsmedicare.com/hhh/medreview/sig_guidelines.pdf
      • The initial benefit period – the certification must be signed by the hospice medical director and the patient’s primary care provider if there is one.
      • Subsequent benefit periods may be signed by the hospice medical director


Source: https://www.cms.gov/Outreach-and-Education/ Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1628.pdf accessed 10/30/17