Discharge or Revocation of Hospice Care

A hospice may discharge a beneficiary when he/she:

  • Is no longer terminally ill;
  • Moves out of the service area; or
  • Is not certified as being terminally ill by their physician.

 
Upon discharge, any days remaining in the benefit period will be forfeited.  The beneficiary may reelect the hospice benefit at any time, as long as coverage criteria are met.

A beneficiary may also choose to revoke the Medicare hospice benefit at any time. To revoke the benefit, the beneficiary must file a signed statement that he or she no longer wishes to receive Medicare coverage of hospice care for the time remaining in that election period. This statement must also include the date the revocation is effective. Any days remaining in the benefit period will be forfeited. The beneficiary may reelect the hospice benefit at any time; however, the reelection may not occur on the same date as the revocation.

In addition to the usual claim information, it is important to complete the following on your final claim to indicate a discharge or revocation.

TOB field on the Fiscal Intermediary Standard System (FISS) Claim Page 01 Enter the type of bill (TOB) 8X1 or 8X4.
STMT DATES FROM field on the FISS Claim Page 01 Enter the “from” date for the billing period.
STMT DATES TO field on the FISS Claim Page 01 Enter the “to” date as the last payable day.  This should be the date of discharge/revocation.  If the beneficiary was discharged or revoked the hospice benefit effective 0429YY, enter 0429YY as the last payable day.  Bill this day at the routing home care rate.
STAT field on the FISS Claim Page 01 Enter “01” if the patient was discharged to home or self-care.  Refer to the Medicare Claims Processing Manual Globe to indicate www link. (CMS Pub. 100-04, Ch. 25 for a list of patient status codes.
OCC CDS/DATE on the FISS Claim Page 01 Enter the occurrence code 42 and the date of discharge or revocation. 
NOTE: It is critical that this code be entered on your final claim to report a revocation indicator at the Common Working File (CWF).  If it is not submitted on the final claim, an adjustment must be made to add occurrence code 42 and date.  
REMARKS on the FISS Claim Page 04 Enter the reason for discharge.  Include your initials and the date the remark was entered.

Reference: Medicare Benefit Policy Manual (CMS Pub. 100-02), Ch. 9, §20.2 Globe to indicate www link.

Page last updated: March 18, 2008

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