42 CFR & Hospice Certification

42 CFR 418.22 is the U.S. law that addresses the medical certification requirements for providers of hospice care. The law defines the method and record-keeping requirements for obtaining certification.

Method

• Prior to submitting a claim to Medicaid/Medicare for payment of services rendered, a hospice agency must obtain medical certification verifying that the prognosis of the terminally ill patient is less than six months. This certification must be accompanied by supporting clinical documentation.

Qualified Physician and Record Keeping

• For the first 90 days of hospice care, the certifying physicians may be the patient's attending physician and the medical director of the hospice agency, after which the medical director may provide ongoing certification. The hospice agency must document the certification in the patient's medical record.

Exception to the Written Certification

• The law allows a hospice agency to accept an oral certification within two days of a patient's eligibility period in order to begin hospice care. However, the written certification is required for claims processing.