Under existing hospice regulations, a physician must initially certify the patient’s terminal condition. In 2024, the Centers for Medicare and Medicaid Services (CMS) will require certifying physicians be enrolled in or opted-out of Medicare for the hospice service to be paid. The requirement is in the Fiscal Year (FY) 2024 Hospice Payment Rate Update Final Rule.

To operationalize this policy, PECOS will send an extract file to FISS of all enrolled and opted-out physicians. Effective May 1, 2024, or as otherwise directed by CMS, FISS shall deny the hospice claim if the physician in the Attending field of the claim is not on the file. CMS will update the existing ordering and referring file on Data.CMS.Gov with an additional column for hospice ordering and referring eligibility. CMS will be applying the edit only to the attending physician NPI field and will not implement soft edit periods prior to May 1, 2024.

Additional information will be provided to hospices and physicians through the Medicare Learning Network in the coming months.