Ask Mary | August 2025

Question: Can a hospice agency’s Medical Director perform the face to face encounter for a hospice patient who is in their third benefit period AND be the certifying physician for the patient’s terminal illness?

Answer:  Recently, CAHSAH has heard that some providers are being cited by CMS surveyors when their hospice Medical Director who performed the face to face encounter also certifies the terminal illness for that same  hospice patient who is in their third hospice benefit period.  Providers should be aware that the Medicare COP  418.22 addresses this issue by stating that the  physician or nurse practitioner who performs the face to face encounter with the patient must attest in writing that he or she had a face to face encounter with the patient, including the date of that visit. When a nurse practitioner OR a non-certifying hospice physician preforms the face to face encounter, they must  state that the clinical findings of that visit were provided to the certifying physician for use in determining continued eligibility for hospice care.  When a hospice medical director  performs the face to face encounter and is also the certifying physician, it is essential to maintain two distinct documents: one detailing the face to face encounter by that hospice medical director, and the other, the Certificate of Terminal Illness, each documented, signed, and dated independently. These documents must not be merged into a single clinical record.