Live Discharge from Hospice Services

The hospice benefit is for individuals who are considered to be terminally ill if the medical prognosis is that the individual’s life expectancy is six months or less if the illness runs its normal course. There are certain situations that the beneficiary may be discharged while still alive. An individual, upon discharge from the hospice during a particular election period for reasons other than immediate transfer to another hospice is no longer covered under the Medicare Hospice Benefit (MHB). An individual may resume the MHB if he or she is again eligible to receive the benefit.

Reasons for Live Hospice Discharge
Beneficiary driven:

  • The beneficiary  revokes the hospice benefit
  • The patient moves out of the hospice’s service area or transfers to another hospice

Agency driven:

  • The hospice determines that the patient is no longer terminally ill
  • Discharge for cause: The hospice discharges the beneficiary citing that the beneficiary's or other persons in the patient’s home) behavior is disruptive, abusive, or uncooperative to the extent that delivery of care to the patient or the ability of the hospice to operate effectively is seriously impaired. The hospice should attempt to resolve these problems satisfactorily before it considers discharge. These efforts by the hospice to resolve the problem(s) must be documented in detail in the patient’s clinical record.

The table below summarizes how hospice discharges would be coded on claims:

Discharge Reason
Coding Required in Addition to Patient Status Code
Beneficiary Revokes
Occurrence Code 42
Beneficiary Transfers Hospices
Patient Status Code 50 or 51; no other indicator
Beneficiary No Longer Terminally Ill
No other indicator
Beneficiary Discharged for Cause
Condition Code H2
Beneficiary Moves Out of Service Area
Condition Code 52


References

  • 42 CFR 418.26 (PDF, 646 KB)
  • Hospice Discharges and Revocations Job Aid (see PDF file below)

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