CMS Delays Start of Hospice Physician Enrollment Requirement

The U.S. Centers for Medicare & Medicaid Services (CMS) has delayed the implementation of hospice certifying physician Medicare enrollment requirements.

CMS delayed the date to enroll in or opt out of Medicare until June 3 for physicians who certify hospice services. Stipulated in the 2024 hospice payment rule and part of the Affordable Care Act, the requirement was previously slated to take effect May 1.

Physicians who don’t comply with the requirement by the new effective date will not receive reimbursement for submitted Medicare claims, CMS stated in an announcement.

“CMS will deny hospice claims if the certifying physician isn’t in our [Medicare Provider Enrollment, Chain and Ownership System (PECOS)] hospice ordering and referring files by then,” the agency said.

The requirement’s delayed start was welcomed by stakeholders in the hospice industry after concerns mounted around the ability for providers to comply.

Calls have grown louder among hospices for greater clarity around the guidelines and claim processing flexibility, among other concerns, according to the National Association for Home Care & Hospice (NAHC) and the National Hospice and Palliative Care Organization (NHPCO). The organizations recently met with CMS officials to address implementation challenges providers have expressed thus far associated with the requirement.

“[We] welcome CMS’ announcement to delay the implementation of the Medicare hospice certifying physician enrollment requirement from May 1 to June 3,” the organizations said in a combined statement shared with Hospice News. “Earlier this week, NAHC and NHPCO met with CMS to relay the concerns of the provider community and request expedient and clear guidance, flexibility in claim processing and Part B Medicare Administrative Contractor (MAC) physician enrollment processing guidance.”

CMS issued a Hospice Certifying Enrollment Q&A in response to the concerns. In it, CMS clarified that the requirement applies to hospice medical directors, physician members of the hospice interdisciplinary group and patient-designated attending physicians who certify patients’ terminal condition under the Medicare hospice benefit. This also includes physicians and other providers billing MACs for hospice services.