Medicare: Medicare won’t pay hospice claims when required face-to-face encounters do not occur timely.


Back Arrow

Back To The Calendar


Topic Medicare: Medicare won’t pay hospice claims when required face-to-face encounters do not occur timely.
Background When a required face-to-face encounter with a hospice patient does not occur timely, the beneficiary is not considered terminally ill for Medicare purposes due to lack of recertification, and therefore is not eligible for the hospice benefit. A hospice must discharge the patient but can readmit the patient once the encounter occurs. Where the only reason the patient ceases to be eligible for the Medicare hospice benefit is the hospice’s failure to meet the face-to-face requirement, the Centers for Medicare & Medicaid Services would expect the hospice to continue to care for the patient at its own expense until the required encounter occurs, enabling the hospice to reestablish Medicare eligibility. This does NOT affect physician claims.
Regulating Body Centers for Medicare & Medicaid Services
Compliance Date 1/9/2012
Consequences Hospices may call on physicians to perform the required face-to-face examination. Patients can be discharged from hospice programs.
Next Steps Be prepared to provide examinations as requests are made.
Find out how TMA can help!