CMS Revises Hospice Physician Enrollment Guidance to Avoid ‘Disruptive’ Impacts

The U.S. Centers for Medicare & Medicaid Services (CMS) has updated its guidance on the recently implemented hospice certifying physician Medicare enrollment requirement. The revisions were fueled by mounting concerns that the requirement posed potential compliance issues.

The requirement stipulated that physicians who certify hospice services must enroll in or opt out of Medicare by June 3 in order to receive reimbursement for submitted claims. Included in the 2024 hospice payment rule and part of the Affordable Care Act, the requirement was previously slated to take effect May 1 and was delayed as providers voiced implementation challenges to regulators.

On Thursday, June 6, CMS reframed some of its guidance to better align with current hospice regulations and provide greater clarity around the process of recertifying patients. CMS retracted initial guidance stipulating that any individual who elects to receive hospice services in a subsequent hospice election would need to be certified by both an attending physician and a hospice clinician as if they were entering care in the initial benefit period


This guideline regarding hospice patient recertification seemed incongruous with existing regulations, according to the National Association for Home Care & Hospice (NAHC) and the National Hospice and Palliative Care Organization (NHPCO). If implemented without the guideline update, the impacts would have been significant for providers and patients, the organizations stated.

“Some instruction provided by CMS was inconsistent with established law and regulations regarding the certification of a patient’s terminal illness for new hospice elections after the first benefit period,” the organizations wrote in a joint statement. “That instruction, if implemented, could have resulted in major negative impacts on hospices and the patients and families they serve. Both organizations requested that CMS retract the guidance to remain consistent with regulation and statute.”

The organizations suggested that CMS’ initial guidance in the new hospice certifying physician Medicare enrollment requirement contradicted pre-existing regulations and provisions of the Social Security Act.


The regulations stipulate that the attending physician must only certify a patient’s terminal illness for the initial hospice Medicare benefit period. Additionally, only one physician must provide this certification for subsequent benefit periods — not both the attending and hospice physician as the guidelines originally stated.

The revisions are a positive step toward greater compliance and understanding among hospices, according to NAHC President Bill Dombi.

“NAHC supports the reasons for the certifying physician enrollment requirement and appreciates CMS’ ongoing engagement on the implementation of the claims processing edits for this requirement,” Dombi said in the statement. “We thank CMS for rescinding the instruction that was not consistent with statute and regulation and had spurred many questions and concerns from hospices. This has alleviated confusion in the industry and avoids disruptive negative impacts.”

CMS’ retraction ensures alignment with existing law and regulations and also alleviates confusion among hospice providers, Medicare Administrative Contractors (MACs) and electronic medical record (EMR) vendors, according to a separate statement NAHC shared with Hospice News.

NAHC and NHPCO anticipate ongoing communication with CMS to gain further clarification around remaining inconsistencies in the physician requirement guidelines. Other concerns have included those regarding operational and staffing challenges associated with implementation.

“We thank CMS for its engagement and partnership on this issue,” NHPCO COO and Interim CEO Ben Marcantonio said. “Considering the staffing constraints many providers currently face, this clarification frees up both operational and physician resources to be best allocated to delivering the highest-quality care to patients and families.”

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