Hospice Center
Spotlights
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The Centers for Medicare & Medicaid Services (CMS) issued a final rule ( CMS-1692-F ) that updates the Medicare hospice wage index, payment rates, and cap amount for fiscal year (FY) 2019. As finalized, hospices will see a 1.8 percent ($340 million) increase in Medicare payments for FY 2019. Additionally, this rule finalizes conforming regulations text changes as a result of section 51006 of the Bipartisan Budget Act of 2018, which amends section 1861(dd)(3)(B) of the Act such that, effective January 1, 2019, physician assistants (PAs) will be recognized as designated hospice attending physicians, in addition to physicians and nurse practitioners. This rule also finalizes changes to the Hospice Quality Reporting Program (Hospice QRP).
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For questions about hospice payment policy, send your inquiry via email to: hospicepolicy@cms.hhs.gov.
Important Links
Regulations and Related Transmittals
Billing & Payment Information
- Electronic Data Interchange (EDI) (Billing) - Medicare information on electronic transactions under HIPAA
- Hospice Aggregate Cap Amount for 2011
- Hospice Aggregate Cap Amount for 2009
- Hospice Aggregate Cap for 2008
Wage Index Files
- FY 2019 Final Hospice Wage Index [ZIP, 99KB]
- FY 2018 Final Hospice Wage Index [ZIP, 111KB]
- FY 2017 Final Hospice Wage Index [ZIP, 95KB]
- FY 2016 Final Hospice Wage Index [ZIP, 269KB]
- FY 2015 Final Hospice Wage Index (Revised 8/7/14) [ZIP, 596KB]
- FY 2014 Final Hospice Wage Index [ZIP, 261KB]
- FY 2013 Final Hospice Wage Index [ZIP, 468KB]
- FY 2012 Final Wage Index [ZIP, 33KB]
- FY 2011 Final Hospice Wage Index [ZIP, 33KB]
- FY 2010 Final Hospice Wage Index [ZIP, 32KB]
- FY 2009 Final Hospice Wage Index [PDF, 249KB]
Managed Care Information
Medicare Hospice Data
Medicaid Information
- FY 2015 Medicaid Hospice Payment Rates - Opens in a new window
- FY 2014 Medicaid Hospice Payment Rates - Opens in a new window
- FY 2013 Medicaid Hospice Payment Rates [PDF, 91KB]
- FY 2012 Medicaid Hospice Payment Rates
- FY 2011 Medicaid Hospice Payment Rates
- Revised FY 2010 Medicaid Hospice Payment Rates
- State Medicaid Manual; (See Section 4305 - Hospice Services)
Enrollment, Participation, & Certification
- Medicare Provider-Supplier Enrollment
- Enrollment Applications
- Hospice Conditions for Coverage (CfCs) & Conditions of Participations (CoPs)
- Hospice Survey & Certification - Certification & Compliance
- Hospice Survey & Certification - Guidance to Laws & Regulations
- CMS-417: "Hospice Request for Certification in the Medicare Program" Form
- Survey & Certification Policy & Memos to States and Regions
Educational Resources
Beneficiary Notices Initiative
- Beneficiary Notices Initiative (BNI) - Use Advanced Beneficiary Notice (FFS ABN-G)
- FFS Expedited Determination Notices
Uninsured Information
Research and Analyses
- June 2016 Literature Review [PDF, 187KB]
- December 2015 Technical Report (Revised 2/1/16) [PDF, 1MB]
- 2015 NHPCO Annual Management & Leadership Conference Presentation by Abt Associates [PDF, 771KB]
- May 2015 Literature Review [PDF, 169KB]
- Hospice Project Background [PDF, 946KB]
- May 2014 Technical Report [PDF, 2MB]
- May 2014 Literature Review [PDF, 813KB]
- April 2013 Hospice Study Technical Report [PDF, 1MB]
- April 2013 Literature Review [PDF, 494KB]
- Data Analysis Presentation [ZIP, 1MB]
- NHPCO’s 29th Management & Leadership Conference [PDF, 874KB]
Hospice Face-to-Face
- Hospice Face-to-Face Guidance PowerPoint
- Update on Physician Signature Requirement and Face-to-Face Encounter Requirements
Quality Initiatives
Other Important Hospice Information
Demonstration
- Active Projects Report - Evaluation of Rural Hospice Demonstration
Coding
- HCPCS - General Information
- HCPCS Release & Code Sets
- ICD-9-CM and ICD-10
- ICD-10
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Claim Adjustment Reason and Remittance Advice Remark Codes - Opens in a new window
National Provider Identifier (NPI)
CMS Manuals & Transmittals
- Manuals
- Internet-Only Manuals (IOMs)
- Transmittals
- To receive changes to the/ CMS Quarterly Provider Update, subscribe to the list.
- Medicare Benefit Policy Manual; Chapter 9 - Coverage of Hospice Services Under Hospital Insurance [PDF, 618KB]
- Medicare Claims Processing Manual; Chapter 11 - Processing Hospice Claims [PDF, 488KB]
- State Medicaid Manual ; (See Section 4305 - Hospice Services) Medicare General Information, Eligibility, and Entitlement Manual; Chapter 4 - Physician Certification and Recertification of Services [PDF, 125KB] - (See Section 60 - Certification and Recertification by Physicians for Hospice Care)
- Provider Reimbursement Manual - Part II
- National Coverage Determinations (NCD) Manual - Pub. 100-03
Medicare Secondary Payer
Fraud & Abuse
How to Stay Informed
- Subscribe now to receive the weekly MLN Connects Provider eNews for the latest Fee-For-Service program information, event announcements, claims and pricer information, and MLN educational product updates.
- Home Health, Hospice & Durable Medical Equipment Open Door Forum
- Questions and Answers: Hospice
- Media Release Database: Press Releases
General Provider Information - Coverage
- Medicare Coverage - General Information
- Medicare Coverage Database - Opens in a new window
- National Coverage Determinations (NCD) Manual - Pub. 100-03
Coordination of Benefits
- Update on Part D Payment Responsibility for Drugs for Beneficiaries Enrolled in Medicare Hospice (11-15-16) [PDF, 173KB]
- Hospice FAQs (v.08.06.2014) [PDF, 77KB]
- Hospice FAQs (v.05.08.14) [PDF, 60KB]
- Part D Payment for Drugs for Beneficiaries Enrolled in Hospice—2015 Guidance [PDF, 152KB]
- Part D Payment for Drugs for Beneficiaries Enrolled in Hospice—Final 2014 Guidance [ZIP, 2MB]
- Part D Payment for Drugs for Beneficiaries Enrolled in Hospice—Request for Comments [PDF, 214KB]
- Clarification of Recovery of Part D Payment for Pain Medications for Beneficiaries Enrolled in Hospice [PDF, 56KB]
- Preventing Part D Payment for Hospice Drugs [PDF, 86KB]
- Announcement of Calendar Year (CY) 2012 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter [PDF, 1MB]
- Announcement of Calendar Year (CY) 2014 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter [PDF, 1MB]
- PDE Guidance for Post Point-of-Sale Claim Adjustments [PDF, 274KB]
- Part D Contacts
- Part D Payment for Drugs for Beneficiaries Enrolled in Hospice - Revised 2014 Guidance [PDF, 162KB]
- Hospice Information for Medicare Part D [ZIP, 2MB]
