Hospices
A. Multiple Practice Locations
Hospices are not precluded from having multiple practice locations if permitted by the regional office (RO). If the RO disapproves an additional practice location, the location must seek Medicare approval as a separate hospice with its own enrollment and provider agreement. (See Pub. 100-07, State Operations Manual (SOM), chapter 2, section 2081, for the policies regarding multiple hospice locations.)
B. Site Visits
• Initial application – If a hospice submits an initial application, the contractor shall order a site visit through the Provider Enrollment, Chain and Ownership System (PECOS) after the contractor receives the tie-in notice (or approval letter) from the RO but before the contractor conveys Medicare billing privileges to the hospice. This is to ensure that the provider is still in compliance with CMS’s enrollment requirements. The scope of the site visit will be consistent with section 15.19.2.2(B) of this chapter. The National Site Visit Contractor (NSVC) will perform the site visit. The contractor shall not convey Medicare billing privileges to the provider prior to the completion of the NSVC’s site visit and the contractor’s review of the results.
• Revalidation – If a hospice submits a revalidation application, the contractor shall order a site visit through PECOS. This is to ensure that the provider is still in compliance with CMS’s enrollment requirements. The scope of the site visit will be consistent with section 15.19.2.2(B) of this chapter.
The NSVC will perform the site visit. The contractor shall not make a final decision regarding the revalidation application prior to the completion of the NSVC’s site visit and the contractor’s review of the results.
• New/changed location - If a hospice is (1) adding a new location or (2) changing the physical location of an existing location, the contractor shall order a site visit of the new/changed location through PECOS after the contractor receives notice of approval from the RO but before the contractor switches the provider’s enrollment record to “Approved.” This is to ensure that the new/changed location is in compliance with CMS’s enrollment requirements. The scope of the site visit will be consistent with section 15.19.2.2(B) of this chapter. The NSVC will perform the site visit. The contractor shall not switch the provider’s enrollment record to “Approved” prior to the completion of the NSVC’s site visit and the contractor’s review of the results.
For more information on hospices, refer to:
• Sections 1861(u) and 1861(dd) of the Social Security Act
• 42 CFR Part 418
• Pub. 100-07, chapter 2, sections 2080 – 2087 (SOM)
• Pub. 100-04, chapter 11 (Claims Processing Manual)
• Pub. 100-02, chapter 9 (Benefit Policy Manual)
See sections 15.19.2.2 through 15.19.2.4 of this chapter for additional hospice site visit information.
A. Multiple Practice Locations
Hospices are not precluded from having multiple practice locations if permitted by the regional office (RO). If the RO disapproves an additional practice location, the location must seek Medicare approval as a separate hospice with its own enrollment and provider agreement. (See Pub. 100-07, State Operations Manual (SOM), chapter 2, section 2081, for the policies regarding multiple hospice locations.)
B. Site Visits
• Initial application – If a hospice submits an initial application, the contractor shall order a site visit through the Provider Enrollment, Chain and Ownership System (PECOS) after the contractor receives the tie-in notice (or approval letter) from the RO but before the contractor conveys Medicare billing privileges to the hospice. This is to ensure that the provider is still in compliance with CMS’s enrollment requirements. The scope of the site visit will be consistent with section 15.19.2.2(B) of this chapter. The National Site Visit Contractor (NSVC) will perform the site visit. The contractor shall not convey Medicare billing privileges to the provider prior to the completion of the NSVC’s site visit and the contractor’s review of the results.
• Revalidation – If a hospice submits a revalidation application, the contractor shall order a site visit through PECOS. This is to ensure that the provider is still in compliance with CMS’s enrollment requirements. The scope of the site visit will be consistent with section 15.19.2.2(B) of this chapter.
The NSVC will perform the site visit. The contractor shall not make a final decision regarding the revalidation application prior to the completion of the NSVC’s site visit and the contractor’s review of the results.
• New/changed location - If a hospice is (1) adding a new location or (2) changing the physical location of an existing location, the contractor shall order a site visit of the new/changed location through PECOS after the contractor receives notice of approval from the RO but before the contractor switches the provider’s enrollment record to “Approved.” This is to ensure that the new/changed location is in compliance with CMS’s enrollment requirements. The scope of the site visit will be consistent with section 15.19.2.2(B) of this chapter. The NSVC will perform the site visit. The contractor shall not switch the provider’s enrollment record to “Approved” prior to the completion of the NSVC’s site visit and the contractor’s review of the results.
For more information on hospices, refer to:
• Sections 1861(u) and 1861(dd) of the Social Security Act
• 42 CFR Part 418
• Pub. 100-07, chapter 2, sections 2080 – 2087 (SOM)
• Pub. 100-04, chapter 11 (Claims Processing Manual)
• Pub. 100-02, chapter 9 (Benefit Policy Manual)
See sections 15.19.2.2 through 15.19.2.4 of this chapter for additional hospice site visit information.
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