Monitoring Your Length of Stay

The Hospice Medicare Benefit is for beneficiaries with a prognosis of six months or less if the disease process follows its normal course. The physician certification of terminal illnesses is a required element to establish hospice eligibility. In the event the beneficiary is still alive at the end of the initial benefit period, the beneficiary can be recertified. The recertification validates the beneficiary still meets hospice eligibility requirements in relation to the prognosis.

There is no limit to the number of recertification benefit periods for a beneficiary. The beneficiary must have a terminal condition as opposed to merely a chronic condition. The physician narrative is required for each certification, and it should document clinical findings which justify the need for hospice services.

The Non-Cancer Length of Stay rates (NCLOS), and Aggregate Length of Stay (ALOS) are two quality measures hospice providers need to monitor. The NCLOS rate is the percentage of your beneficiaries that outlive the six month prognosis. For example, a NCLOS rate of .20 means 20 out of every 1000 beneficiaries outlives the 6 month prognosis. Providers can find their NCLOS rates in the Palmetto GBA eServices portal. Within eservices you will see your provider specific report, which will show if your NCLOS rate is in line with the state, regional, and jurisdiction rates. The current NCLOS rate by state is below.

State
Number of
Providers
Average Length of
Stay (In Days)

NCLOS Rate
ALABAMA
101
166
0.27
ARKANSAS
37
119
0.17
FLORIDA
41
156
0.24
GEORGIA
189
156
0.24
ILLINOIS
113
114
0.17
INDIANA
80
121
0.18
KENTUCKY
23
81
0.11
LOUISIANA
128
158
0.24
MISSISSIPPI
85
147
0.23
NEW MEXICO
40
165
0.25
NORTH CAROLINA
75
124
0.19
OHIO
128
137
0.20
OKLAHOMA
114
157
0.24
SOUTH CAROLINA
81
153
0.24
TENNESSEE
55
129
0.19
TEXAS
539
174
0.26

The ALOS is the average length of stay for all of your patients. This is the average measured in days. Providers can monitor their length of stay by checking their PEPPER reports (Program for Evaluating Payment Patterns Electronic Report). The current ALOS rate by state is below.

State
ALOS 
ALABAMA
161.7
ARKANSAS
111.5
FLORIDA
142.9
GEORGIA
146.1
ILLINOIS
102.1
INDIANA
110.0
KENTUCKY
73.4
LOUISIANA
146.8
MISSISSIPPI
140.0
NEW MEXICO
148.7
NORTH CAROLINA
113.4
OHIO
124.7
OKLAHOMA
147.9
SOUTH CAROLINA
144.6
TENNESSEE
117.4
TEXAS
161.8

For information on certification and recertification view the GPO website.

For NCLOS reports:

For ALOS reports - https://www.pepperresources.org/

Contact Palmetto GBA JM Part HHH Medicare

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Contact a specific JM HHH department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

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