CMS Updates On Hospice Election Form, Revocation, And Designation Of Attending Physician

On April 3, 2015, the Center for Medicare & Medicaid Services (“CMS”) issued Change Request 9114 to Medicare Administrative Contractors (“MACs”) implementing the changes finalized in the FY 2015 hospice rule regarding election, revocation, and designation of an attending physician. These changes are effective May 5, 2015.


Upon electing hospice care, a beneficiary waives the right to Medicare payment for services related to the terminal illness and related conditions during a hospice election, except when provided by the designated hospice or the individual’s attending physician if he/she is not employed by the designated hospice. Prompt filing of the notice of election of hospice care (“NOE”) with the appropriate Medicare contractor is required to properly enforce the waiver and prevent inappropriate payments to non-hospice providers. Upon discharge from hospice or revocation of hospice care, the beneficiary immediately resumes Medicare coverage that had previously been waived by the hospice election.

Choice of Attending Physician

CMS’s updated policy statement indicates that a NOE must clearly indicate the patient’s choice of attending physician or nurse practitioner (NP). This requires at least the attending physician or NP’s name and National Provider Identifier (NPI). As before, the NOE must also comply with Medicare regulations regarding the content of an election statement (listed at 42 C.F.R. 418.24(b)). If the patient (or the patient’s representative) wishes to change his or her designated attending physician, they must follow a procedure similar to that which currently exists for changing a designated hospice facility. Specifically, the patient (or representative) must file a signed statement with the hospice that identifies the new physician in enough detail that it is clear which physician or NP is designated. In addition, the statement must include the following: (1) the effective date of the change, (2) the signature by the patient (or representative) with an acknowledgement that this change in attending physician is the patient’s choice, and (3) the date of signature. Note that the effective date cannot be earlier than the date the statement is signed.

Timely Filing of NOE

NOEs must be filed and accepted by the MAC within five calendar days after the hospice admission date. Note that where an NOE is not timely filed, Medicare will not cover and pay for the hospice care from the hospice admission date to the date the NOE is submitted or accepted by the MAC. These days become a provider liability, and providers may not bill beneficiaries for them. For this reason, it is important for hospice providers to ensure that protocols are in place for ensuring timely filing of NOEs. There are some situations in which Medicare will waive the consequences of a late-filed NOE. Exceptions to the payment policy will be made in the following circumstances: (1) fires, floods, earthquakes, or other unusual events that inflict extensive damage on the hospice’s ability to operation; (2) an event that produces a data filing problem due to a CMS or MAC systems issue that is beyond the control of the hospice; (3) a newly Medicare-certified hospice that is notified of that certification after the Medicare certification date, or which is awaiting its user ID from its MAC; or (4) other circumstances determined by the MAC or CMS to be beyond the control of the hospice. Note that the hospice will have to affirmatively request an exception under one of these categories when the NOE is filed in order to receive the waiver.

Termination of Hospice Care and Resuming Medicare Coverage

Upon discharge from hospice or revocation of election of hospice care, the beneficiary immediately resumes the Medicare coverage that had previously been waived by the hospice election. Hospice providers should insure prompt recording of the beneficiary’s discharge or revocation in the claims processing system. This will prevent the beneficiary from experiencing possible delays in accessing needed medical care.

To revoke election of hospice care, a patient (or patient’s representative) must file a document with the hospice provider that includes: (1) a signed statement that the individual revokes the election for Medicare coverage of hospice care for the remainder of the election period; and (2) the effective date of the revocation. The effective date cannot be earlier than the date on which the revocation is made. Note that while the patient (or patient’s representative) may revoke the election of hospice care at any time in writing, a hospice cannot “revoke” a patient’s election.

If you have any questions regarding the upcoming changes to Medicare regulations pertaining to hospice election and revocation, designation of an attending physician, or regarding the impact of the FY 2015 rule changes on your hospice facility, please contact Jennifer Gross or Briar Siljander at (810) 227-3103.

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