CMS's own hospice claims data show the share of patients leaving hospice alive, rather than through death, rising every year since fiscal year 2020. The agency's April 2025 Hospice Monitoring Report puts the national live discharge rate at 16.0% in FY2020 and 19.0% in FY2024, with the share of live discharges attributed to patients moving out of the service area rising and the share attributed to a finding that a patient is no longer terminally ill falling over the same period. For a hospice already answering a documentation request, a rising live discharge rate adds one more question to every chart: did the patient revoke the election, or did the hospice make the clinical call. A hospice that cannot show which one applies is exposed the moment a reviewer pulls the file.
The Live Discharge Rate CMS Is Tracking
CMS's Hospice Monitoring Report is built from 100% of Medicare fee-for-service hospice claims and sorts every live discharge into one of five categories: revocation, a finding that the patient is no longer terminally ill, the patient moving out of the hospice's service area, transfer to another hospice, or discharge for cause. In FY2024, revocation accounted for 35.3% of live discharges and a no-longer-terminally-ill finding accounted for 32.9%. Moving out of the service area accounted for 16.4%, transfer for 13.6%, and discharge for cause for 1.9%. The overall rate rose every year measured: 16.0% in FY2020, 16.9% in FY2021, 17.2% in FY2022, 18.3% in FY2023, and 19.0% in FY2024.
Revocation Is the Patient's Act, Discharge Is the Hospice's
The two largest categories carry different paperwork under different regulations. Under 42 CFR 418.28, revocation belongs to the patient or representative: they file a signed statement revoking the election, and the hospice must notify its Medicare contractor within 5 calendar days. A hospice-initiated discharge under 42 CFR 418.26 starts from the hospice's own determination: that the patient is no longer terminally ill, has moved outside the service area, or should be discharged for cause. Before that determination takes effect, the hospice must obtain a written physician's discharge order from the medical director, a physician designee, or a physician member of the interdisciplinary group.
What the Chart Needs Before a Discharge for Improvement or Cause
Section 418.26 requires more than the physician's signature on the discharge order. The hospice must maintain a discharge planning process that accounts for the possibility that a patient's condition stabilizes to the point that continued certification cannot be supported, including planning for any family counseling or patient education the patient needs before that discharge. Discharge for cause carries its own proof requirements: advise the patient that discharge for cause is being considered, make a serious effort to resolve the problem, confirm the proposed discharge is not actually driven by the patient's use of necessary hospice services, and document both the problem and the resolution effort.
How a Live Discharge Pattern Becomes an Audit Trigger
CMS already scores every Medicare-certified hospice on claims-based measures that reach live discharges directly. The Hospice Care Index includes ten such indicators, among them Early Live Discharges, Late Live Discharges, and two measures CMS labels Burdensome Transitions, both of which track a live discharge followed by hospitalization. The agency went further in the FY 2027 Hospice Wage Index final rule (CMS-1851-F, issued July 30, 2026), finalizing a Service and Spending Variation Index built from nine claims-based measures of hospice utilization and non-hospice spending. CMS describes a higher SSVI score as one that can signal potentially inappropriate utilization or concerns with quality of care or compliance. A live discharge pattern well outside the national trend does not need a complaint to draw that score. The claims data alone can put it there.
A hospice that cannot show whether a live discharge was the patient's revocation or the hospice's own clinical determination is handing a reviewer the exact distinction a discharge audit is built to test.
Why Early Legal Counsel Is Critical
It is critical that hospices promptly retain experienced healthcare defense counsel once an additional documentation request, a Targeted Probe and Educate review, or a Recovery Audit Contractor (RAC) review names live discharge documentation as the issue. Early legal intervention can protect the hospice's rights, make certain the response distinguishes revocation from hospice-initiated discharge correctly, avoid inadvertent admissions, and preserve the defenses available before extrapolation turns a sample of flagged discharges into a full-population recoupment demand. Delaying legal representation can significantly affect the outcome of a matter and expose the hospice to unnecessary risk.
Health Law Alliance's attorneys have overseen 2,000+ audits and handled 5,000+ matters, with 25+ years of experience.
How Health Law Alliance Can Help
Health Law Alliance's hospice and home health audit defense attorneys review live discharge documentation before a response is due, matching each discharge to the record the applicable regulation requires. For how a documentation request can escalate once a Medicare Administrative Contractor opens a Targeted Probe and Educate review, see Health Law Alliance's prior explainer, MAC Targeted Probe and Educate: What TPE Really Means. For the clinical record a Local Coverage Determination requires behind a terminal prognosis, see Local Coverage Determinations: How MACs Use LCDs in an Audit. If your hospice has received a documentation request citing live discharge rates, contact Health Law Alliance for a free, confidential consultation.
