Medicare administrative contractor CGS recently provided a list of top medical review denial reasons for hospice providers in January and February of 2026.
The top reason was “terminal prognosis not supported.” See the top five reasons below.
CGS shares these tips when supporting the six-month terminal prognosis:
- Documentation to support terminal prognosis should be objective and include quantifiable values/measures (ex. Pounds, 4 on a scale of 1-5, inches, etc.)
- Documentation must “paint a picture” of the patient, their conditions and symptoms which support a life expectancy of 6 months or less.
- Avoid the use of vague statements such as: “disease progressing” or “slow decline”
Top five hospice medical review denial reasons (January-February 2026)
- Terminal prognosis not supported: 133 denials
- Notice of election is invalid: 101 denials
- Medical records not received/not received timely: 23 denials
- Physician narrative missing/invalid: 7 denials
- Certification missing: 5 denials
See more: