Certification of Terminal Illness

42 CFR 418.22 · MBPM Pub. 100-02, Ch. 9, §20.1

Hospice CoP Training

Educational Use Only

Benefit Period Structure & Signatory Rules

Period	Duration	Who Must Certify	F2F Required?
1st	90 days	Hospice MD/designee/IDG physician PLUS attending physician (if patient has one)	No
2nd	90 days	Hospice MD/designee/IDG physician only	No
3rd	60 days	Hospice MD/designee/IDG physician only	Yes - within 30 days before period start
Each subsequent 60-day	60 days	Hospice MD/designee/IDG physician only	Yes - within 30 days before period start

Required Certification Content (Every Period)

No templated narratives. CMS requires a patient-specific narrative describing the individual's clinical trajectory and prognosis-supporting findings. Copied boilerplate is a high-frequency denial trigger in medical review.

Required Element	Operational Requirement	Common Failure
6-month prognosis statement	States prognosis of ≤6 months if illness runs normal course	Generic language without patient context
Patient-specific narrative	Individual clinical findings supporting prognosis	Templated or copied from prior period
Supporting clinical information	In record; may initially be verbal but must be documented	Narrative present; no corresponding chart documentation
Physician signature and date	All certifications signed and dated by certifying physician(s)	Unsigned; missing signature date (FY 2026 rule)
Benefit period dates	Specific start and end dates included in certification	Missing dates; dates misaligned to election timeline

Face-to-Face Encounter (3rd+ Benefit Periods)

Rule	Requirement	Authority
Who may conduct	Hospice physician or hospice NP only - NOT the attending	42 CFR 418.22(a)(4)
Timing window	Within 30 calendar days before the benefit period being recertified	42 CFR 418.22(a)(4)
Attestation must include	Encounter date, practitioner signature, AND signature date (FY 2026 restored)	42 CFR 418.22(b)(4); FY 2026 Final Rule
Telehealth authority	Verify current CMS guidance - limited statutory extension; not permanent	CMS Hospice Center guidance

Certification Timing Quick Rules

Written certification: Must exist before claim submission
Oral exception: If written cert unavailable within 2 calendar days of period start - oral certification within 2 days; written before claim submission 42 CFR 418.22(a)(3)(i)
Early completion limit: No more than 15 calendar days before benefit period start date 42 CFR 418.22(a)(3)(ii)

Claim denial risk: Certification that does not meet timing rules is not merely a survey deficiency - missing or late certification results in claim denial for the entire benefit period until a compliant certification is obtained.

Educational Use Only. Not legal advice. Verify against current primary sources.