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NURSING FACILITY DISCHARGE/TRANSFER/HOSPICE FORM - tn 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by filling out the Member Information section. Enter the member's last name, first name, date of birth, MCO ID, and SSN accurately.
- In the Representative/Designee/Power of Attorney section, provide the representative's name and phone number if applicable. Indicate if the member elects to receive hospice care.
- Fill in the Hospice Effective Date and details about the discharging/transferring facility, including provider numbers and contact information.
- Specify where the member is discharging to by selecting one of the options provided (e.g., another NF or home) and complete any relevant sections based on your selection.
- Complete any additional fields regarding effective dates for enhanced respiratory care if applicable.
- Review all entered information for accuracy before submitting. Use our platform’s features to save or share your completed form as needed.
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How many times can a hospice patient transfer in a benefit period?
Hospices must not send an 8XC if the CMS Certification Number (CCN) is the same. In this case, the patient isnt transferred to another hospice, theyre transferred to another location of the same hospice. A patient can change hospices only once per benefit period (60-day or 90-day).
How does hospice transfer work?
An individual may change the designation of the hospice they receive care from only once in each election period. The change of hospice is not considered a hospice revocation. The beneficiary must file a signed statement with the hospice they have received care from and the newly designated hospice.
What is a hospice transfer?
Change (transfer) of a Designated Hospice Provider. An individual may change, once in each election period, the designation of the particular hospice from which he or she elects to receive hospice care.
What is the 5 day rule for hospice patients?
The hospice interdisciplinary team (IDT) has 5 calendar days from the effective date of the hospice election statement to complete the comprehensive assessment. CMS does not dictate how the comprehensive assessment is completed or what forms a hospice provider utilizes to document the comprehensive assessment.
What does hospice transition mean?
A patient who is transitioning in hospice is actively approaching the end of their life. This is different from a terminal diagnosisthe transition is marked by physical and emotional changes that signal the body is beginning to shut down.
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