The CMS threshold, why hospices trip it, and what to change — starting this week.
Status: proposed, not final. These scores come from the SSVI file CMS published with the FY2027 Hospice Wage Index proposed rule (CMS-1851-P, April 2026). CMS is explicit that the SSVI is not a finding of fraud, waste, or abuse — it flags claims patterns that may warrant additional oversight.
23.3% of scored hospices nationally tripped this measure in FY2025.
This measure tracks the share of patients who died in hospice, whose last two days were billed at Routine Home Care, and who received at least one skilled visit during those last two days. A "skilled visit" means RN, LPN, medical social services, or therapy — not aides and not chaplains — and it is claims-based, so the visit only counts if it was billed with the correct revenue code. A hospice at or below the 25th percentile nationally gets flagged.
Percentile-based thresholds are recalculated by CMS every fiscal year, so the line moves as the industry moves.
No. Only nursing (RN or LPN), medical social services, or therapy visits count — and only if billed with the correct revenue code.
Document the refusal — CMS’s measure has no built-in exception for it. A single declined visit will not sink your score, but the pattern across your census is what drives the percentile.
Look up your score free — the breakdown shows your raw value on this exact measure next to the CMS threshold. Or browse scores by state.
Friday, July 17 · 40 minutes · Hosted by Miles Pickens, Hospice Engine
Bring your score. We’ll walk through what’s driving it — spending, utilization flags, percentile rank — and what to change first. Zoom link sent by email when you register. The first 3 seats each Friday are free.
The Friday SSVI Q&A is free for the first 3 seats. For agency-specific work, book an SSVI consultation.