Reason Code: 55H1L

Error Description:

According to the Medicare Hospice requirements, the information provided does not support a terminal prognosis of six months or less.

Avoiding/Correcting This Error

Clinical progress notes should show evidence of a steady decline or downward trajectory in the beneficiary’s clinical status over time. Documentation should be objective, measurable and must support a life expectancy of six months or less. Beneficiaries who have improved or stabilized overtime and no longer have a reasonable expectation of a prognosis of six months or less should be discharged from the Medicare hospice benefit. There should be consistency between the certification documents and the hospice clinical progress notes.