Hospice Face-to-Face Recertification Encounter

Documents the hospice physician or nurse practitioner face-to-face encounter required before the third and each subsequent benefit period, including eligibility attestation and supporting clinical findings.

Encounter Timing and Benefit Period

• Patient Identifier
  Enter the minimum necessary patient identifier used by your organization for the audit trail.
• Face-to-Face Encounter Date
  Date the hospice physician or nurse practitioner completed the encounter.
• Benefit Period
  Select the benefit period this recertification supports.
• Encounter Location
  Where the face-to-face encounter occurred.
• Other Location Details
  Provide details only if 'Other' was selected for the encounter location.

Practitioner Information

• Practitioner Name
  Enter the name of the hospice physician or nurse practitioner.
• Practitioner Role
  Select the clinician role for this encounter.
• NPI
  Optional National Provider Identifier if used by your compliance process.
• Contact Information
  Optional contact information for follow-up or audit review.

Clinical Findings Supporting Eligibility

• Functional Decline Observed
  Select all findings observed during the encounter.
• Other Functional Decline Details
  Describe any additional decline findings not listed above.
• Clinical Summary
  Briefly summarize the patient’s current condition and why it supports ongoing hospice eligibility.
• Findings Support Terminal Prognosis
  Confirm whether the encounter findings support a terminal prognosis of six months or less if the disease runs its normal course.

Attestation and Submission

• Attestation Statement
  I attest that I personally completed the face-to-face encounter and that the documentation accurately reflects the patient’s condition and hospice eligibility review.
• Attested By
  Enter the name of the practitioner attesting to this documentation.
• Attestation Date
  Date the attestation was completed.
• Documentation Acknowledgment
  Confirm that you understand this submission will be stored in the patient record and may be reviewed for compliance and audit purposes.