Hospice Certification of Terminal Illness (PalmettoGBA)

For a patient to be eligible for the Medicare hospice benefit, the beneficiary must be certified as being terminally ill. A beneficiary is considered to be terminally ill if the medical prognosis determines the individual's life expectancy is six months or less if the illness runs its normal course. The certification/recertification is critical to ensure Medicare payment for the hospice services you provide.

Timeframe for Certification/Recertification
The hospice must obtain oral or written certification of terminal illness, no later than two calendar days (by the end of the third day) after the start of each benefit period (initial and subsequent). 

Initial certifications may be completed up to 15 days before hospice care is elected. 

Recertifications may be completed up to 15 days before the start of the next benefit period.

If written certification/recertification cannot be obtained within two calendar days, an oral certification must be obtained. The hospice must determine who may accept an oral certification from a physician in compliance with state and local regulations.

Click here for full PalmettoGBA article.