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Printed Date: 9/22/2015
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.
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.
For information on certification and recertification view the GPO website.
For NCLOS reports:
For ALOS reports - https://www.pepperresources.org/
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Last Updated: 04/19/2018