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.
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Sign the Hospice Election Statement with the hospice provider
The patient (or authorized representative) signs the election statement when choosing hospice care.
Filing Deadline
Effective on the date specified in the election statement. Can be filed at any time when the patient has a terminal prognosis of 6 months or less.
Immediate. Hospice benefits begin on the effective date stated in the election. The hospice provider notifies Medicare.
Medicare hospice benefit begins covering hospice services: nursing, aide, social work, chaplaincy, medications for symptom management, DME, and bereavement support. The patient waives curative treatment for the terminal illness but can still receive treatment for unrelated conditions.
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.
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.
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.
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.
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.
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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