Tip for Discharge Order

Patients have the right to appeal a discharge for cause through the hospice's grievance process

Tip for Discharge Order

If discharged because no longer terminally ill, the patient can be re-admitted later if their condition declines

Tip for Discharge Order

Comprehensive discharge planning is required — ensure the patient has a primary care physician and necessary services in place

HospicemoderateDoctor signature required

Hospice Physician Discharge Order

Discharge Order · Hospice Agency

Written physician order required before discharging a patient for any reason other than revocation, transfer, or death. Documents the clinical rationale for discharge.

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Where to Submit This Form

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The hospice medical director issues a discharge order

Discharge from hospice can occur for three reasons: the patient is no longer terminally ill, the patient moves out of the service area, or the patient is discharged for cause.

Filing Deadline

Hospice must provide a 5-day advance notice of discharge for cause. Discharge because the patient is no longer terminally ill should occur when the medical director determines the 6-month prognosis criteria are no longer met.

Required Attachments

📎 Hospice discharge order signed by the medical director
📎 Clinical documentation supporting the discharge reason
📎 Discharge planning documentation
📎 5-day written notice (for discharge for cause)
📎 Patient/family education about post-discharge care and rights

Processing Time

Immediate upon the medical director's order. The hospice provider submits a NOTR to CMS within 5 calendar days.

What Happens Next

Regular Medicare benefits resume. The hospice provider coordinates transition to appropriate care providers. The patient can re-elect hospice in the future if they again meet eligibility criteria.

Tips for This Form

✓ Patients have the right to appeal a discharge for cause through the hospice's grievance process
✓ If discharged because no longer terminally ill, the patient can be re-admitted later if their condition declines
✓ Comprehensive discharge planning is required — ensure the patient has a primary care physician and necessary services in place
✓ Document the discharge reason thoroughly to support the decision in case of audit or appeal

More Hospice Forms

Hospice Election Statement

Hospice Election (CMS model) · CMS / Hospice Agency

Elects the Medicare hospice benefit. Identifies the hospice and attending physician. Acknowledges waiver of curative treatment for the terminal illness. Triggers two 90-day benefit periods followed by unlimited 60-day periods.

Hospice Certification / Recertification

Hospice Certification (CMS) · CMS

Physician certification that the patient has a terminal illness with a prognosis of 6 months or less. Required at the start of each benefit period. Face-to-face encounter required before the third benefit period and each subsequent period.

Hospice Notice of Election (NOE)

NOE (CMS electronic) · CMS

Electronic notification to Medicare contractor that a beneficiary has elected hospice. Must be filed within 5 calendar days of the election effective date. Late filing results in provider liability for uncovered days.

Hospice Notice of Termination/Revocation (NOTR)

NOTR (CMS) · CMS

Filed when a hospice beneficiary is discharged alive or revokes the election. Must be submitted within 5 calendar days of the effective date.

Hospice Revocation Statement

Revocation Statement · Hospice Agency

Written statement revoking hospice election for a specific benefit period. Patient may re-elect hospice for remaining benefit periods. Verbal revocation is not acceptable; must be in writing.

Hospice Transfer Form

Transfer Form · Hospice Agency

Change of designated hospice provider (allowed once per election period). Not a revocation. Receiving hospice files a new NOE; benefit period dates are unaffected.

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the Hospice Agency or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.