Hospice benefit periods, recertification and the face-to-face visit

Benefit period calculator

Enter the first day of the election. If the patient is re-electing after a revocation or a discharge, choose which period this election starts: a patient who used the first period and revoked starts the second; a patient beyond the second period starts a later 60-day period. The dates stay in your browser.

What are the hospice benefit periods?

An initial 90-day period, a subsequent 90-day period, then an unlimited number of subsequent 60-day periods (42 CFR 418.21). The periods run consecutively while the patient stays on hospice. A patient may be on hospice for as long as the physician continues to certify a six-month prognosis; there is no lifetime cap. When a patient revokes or is discharged, the remaining days of that period are forfeited, and a later election begins with the next period.

When is recertification due?

For the first period, the hospice medical director or physician member of the interdisciplinary group and the attending physician, if any, each certify. For each later period, the hospice physician recertifies. The written certification must be obtained within 2 calendar days after the period starts; a verbal certification within those 2 days is acceptable if the written one follows before the claim (42 CFR 418.22(a)(3)). The certification states the prognosis, the clinical findings that support it and, from the third period on, the face-to-face attestation. Certifications may be completed up to 15 days before the period starts (418.22(a)(3)(i)).

What is the face-to-face requirement, and who can do it?

Before recertifying for the third benefit period and each period after it, a hospice physician or a hospice nurse practitioner must have a face-to-face encounter with the patient to gather clinical findings about the prognosis. The encounter must happen no more than 30 calendar days before the start of the period, and the physician who recertifies attests in writing that it took place and when, and, if a nurse practitioner did it, that the findings were used (42 CFR 418.22(a)(4)). An exception allows the encounter within 2 days after admission when the patient is newly admitted in a third or later period, and in some cases the patient dies before it can occur.

What happens to the periods after a revocation or a live discharge?

The patient gives up the remaining days of the current period. A later election resumes with the next period in sequence: after revoking in the first period, the second 90-day period; after that, a 60-day period, which means the face-to-face requirement applies to the new election. Read the family page on leaving hospice and the rules on discharge.

What does the family see?

Families ask how long Medicare will pay. The honest answer is for as long as the patient remains eligible, period by period. We explain it to them in plain words at how long will Medicare pay for hospice.

Common questions about benefit periods

Related guides

The eligibility guidelines, the eligibility scales, levels of care criteria and how to refer.