Beneficiaries who elect hospice care forego standard Medicare coverage for conditions related to the terminal illness, but standard Medicare benefits are provided for conditions unrelated to the patient's terminal illness. While many factors can influence when to admit patients to hospice care, it is important to distinguish between admitting a patient to a hospice program and certifying a patient for the Medicare hospice benefit. Based on an individual hospice's admission criteria, some patients may be admitted to hospice care prior to an estimated six months before death but without reimbursement under the Medicare hospice benefit. By long-established law, patients can be certified for the Medicare hospice benefit only when a physician determines that a patient's life expectancy is six months or less if the illness runs its normal course. The hospice guidance also includes information on how to assess the effectiveness of a compliance program.
Documentation is key to demonstrating the effectiveness of a provider's compliance program.