Documentation that does not support a hospice patient’s prognosis of six months or less continues to be a top cause of pre-payment denials related to length of stay, according to Medicare Administrative Contractor (MAC) Palmetto GBA.  
 
The results came from a pre-payment review for hospice length of stay in Alabama, Georgia, Illinois, South Carolina, Tennessee and Texas from April to June 2025. Palmetto published its results on Oct. 7, 2025. 
 
Of 277 claims submitted by providers during this timeframe, 62 were denied. This cumulated in a total of nearly $213,000 in denials. 
 
Documentation failing to support the terminal diagnosis topped the list of denial reasons at 35%, but it wasn’t the only common concern. Other noted reasons include: 
  • Hospice election statement did not meet statutory or regulatory requirements (20%) 
  • Face-to-face encounter was not met (15%) 
  • No certification for dates billed (10%) 
  • No plan of care (5%) 
To view Palmetto’s TPE results, visit https://palmettogba.com/jmhhh/did/85yvlhn2pj.