Hospice documentation has always been high-stakes. A missing certification, an unsigned order, an overdue care plan update — any of these can trigger a denial, flag a survey, or put your agency's billing at risk.
In 2026, the documentation requirements are more detailed than ever. The HOPE Tool added new structured assessment timepoints. CMS tightened face-to-face attestation rules. ADR activity is up across the industry.
Use this checklist to make sure your agency has everything it needs, before a surveyor or ADR request does the checking for you.
Admission Documentation
- Certification of Terminal Illness (CTI): Signed by the patient's hospice physician and attending physician, certifying a prognosis of six months or less. Both signatures must be dated. CMS clarified that the IDG physician may also recommend admission and certify terminal illness under the FY 2026 rule.
- Face-to-Face Encounter documentation: Required at the third benefit period and each subsequent recertification. Under the 2026 final rules, the attestation no longer needs to be a separate document — it can be a signed and dated section of the recertification form or a clinical note. The practitioner performing the F2F does not need to be the certifying physician.
- Election of Hospice Benefits: Signed by the patient or authorized representative.
- Individualized care plan: Completed at admission and updated at every recertification and any time there is a significant change in condition.
- HOPE Admission Assessment: Completed within days 0–5 after hospice election. Required for HQRP compliance. Submitted through iQIES.
Ongoing Clinical Documentation
- Visit notes for every clinician visit: Must reflect what was observed, what was done, and the patient's response. Vague or template-generated notes draw attention during surveys.
- Physician orders: All orders must be signed by the authorizing physician before being carried out. Unsigned orders are the most common finding in hospice surveys.
- Medication records: Current medication list including all controlled substances, updated with every change.
- HOPE Update Visit 1 (HUV1): Completed within the first 30 days of enrollment. Submitted to iQIES within 30 days of the assessment date.
- HOPE Update Visit 2 (HUV2): Required if the patient remains enrolled beyond the HUV1 window.
- Symptom Follow-up Visits (SFVs): Required within 2 calendar days of any Admission or HUV assessment where the patient scores moderate (4+) or severe (7+) on a symptom impact item. In-person only. Up to 3 SFVs per hospice stay.
Recertification Documentation
- Recertification of terminal illness: Required at the start of each benefit period. Must be signed and dated before the benefit period begins.
- Updated care plan: Must reflect current clinical and psychosocial needs. An outdated care plan will flag during a survey.
- IDG meeting notes: Documented at least every 15 days. Notes should reflect actual clinical discussion, not boilerplate entries.
- Face-to-face encounter (third benefit period and beyond): See admission section for 2026 documentation requirements.
Discharge and Transfer Documentation
- Discharge summary: Documents reason for discharge, patient condition, and referrals.
- HOPE Discharge Assessment: Required for all discharges. Submitted to iQIES within 30 days.
- Revocation of Hospice Benefit: If applicable, signed and dated by the patient.
- Notice of Election/Revocation: Filed with the Medicare contractor within required timeframes.
Common Documentation Gaps That Trigger Problems
- Late visit documentation. Set a same-day or next-morning standard and track compliance by clinician.
- Unsigned physician orders. Build a real-time order tracking system so your team isn't chasing signatures manually.
- Outdated care plans. Make care plan review a required step at every recertification.
- Missing HOPE SFV documentation. SFVs are triggered by symptom scores. Build the task into your workflow.
WorldView's physician order tracking, document management, and mobile tools help hospice agencies stay on top of every item on this list — in real time, across locations. Schedule a demo to see how it works.