Hospice: New Requirement for Physicians Who Certify Patient Eligibility Effective June 3

For Medicare to pay for hospice services, the following physicians must enroll in Medicare or opt out by June 3, 2024:

1. The hospice medical director or the physician member of the hospice interdisciplinary group who certifies the patient’s terminal condition
2. Patient-designated attending physician (if they have one) who certifies their terminal condition

The Centers for Medicare & Medicaid Services (CMS) will deny hospice claims if the certifying physician isn’t in the PECOS hospice ordering and referring files by then.

You don't need to do anything if you’re currently enrolled or opted out.

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.

More information:

• Hospice Certifying Enrollment Q&A
• Hospice Claims Edits for Certifying Physicians MLN Matters Article
• FY 2024 Hospice final rule 
• Instruction to your Medicare Administrative Contractor