Understanding Medicare’s New Clinical Outcome Reporting Requirements

Medicare’s approach to hospice clinical outcome reporting is changing and it is critical for providers to understand what this shift means for compliance and reimbursement. The transition from HIS to HOPE introduces new expectations, new workflows and new submission requirements that impact every hospice organization.

From HIS to HOPE: What’s Changing

For years, hospice providers reported clinical data through the Hospice Item Set or HIS. This process focused on a defined set of clinical questions submitted to Medicare. That framework is now being replaced by HOPE, a more comprehensive and enhanced set of clinical outcome measures.

HOPE expands the scope of data collection and changes how information is submitted. This is not a simple update to an existing system. It is a new reporting process that requires providers to adjust internal workflows and ensure clinical documentation supports the expanded data set.

A New Submission Process and Portal

Along with the transition to HOPE comes a new Medicare submission portal. Hospice providers must enroll in this portal to upload required data. Enrollment is not optional and the system officially goes live on October 1.

Failure to complete enrollment or submit data correctly can create gaps in reporting. Those gaps can quickly turn into compliance issues if teams are not prepared ahead of time.

Why Education and Preparation Matter

Medicare has made it clear that providers who fail to meet required submission thresholds will face payment penalties. Accurate and timely reporting is directly tied to reimbursement.

We strongly encourage providers to stay informed through official Medicare resources. Medicare-hosted materials, industry webinars and EMR-led education sessions all provide valuable guidance. Taking advantage of these resources now helps reduce risk later.

Supporting Accurate and Compliant Reporting

Our goal is to help hospice teams navigate these changes with confidence. By understanding the new HOPE requirements and preparing for the updated submission process, providers can protect revenue, maintain compliance and continue focusing on patient care. Proactive planning today prevents costly penalties tomorrow.