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Claims-based formula for the last-days-of-life visit measure
The share of qualifying patient stays in which in-person RN or medical social worker visits occurred on at least two of the final three days of life, derived entirely from hospice claims with no separate assessment submission required.
The HVLDL calculation is the claims-based formula Medicare uses to score Hospice Visits in the Last Days of Life: the percentage of qualifying patient stays in which the patient received in-person visits from an RN or medical social worker on at least two of the final three days of life. The final three days are the day of death, the day before, and two days before.
The measure is built entirely from hospice claims, so no separate assessment submission is required (CMS HVLDL measure specifications)[1]. The numerator is the number of stays in which the patient received in-person RN or medical social worker visits on at least two of the last three days of life; if both disciplines visit on the same date, that date still counts only once. The denominator is qualifying patient stays, and CMS excludes stays where the patient did not die while in hospice care, received Continuous Home Care, Inpatient Respite Care, or General Inpatient Care during the final three days of life, or was enrolled for fewer than three days (CMS HVLDL measure specifications)[1]. The result is published on Care Compare as part of the Hospice Quality Reporting Program, where HVLDL replaced the older Hospice Item Set measure on visits when death is imminent (CMS hospice current measures)[2]. The same visit records that drive the score also drive Service Intensity Add-on payment.
Because HVLDL is calculated entirely from claims, visit coding determines both a public quality score and SIA payment from the same set of records. Incomplete visit discipline or missing dates and times on a claim affect the HVLDL numerator and, for the seven-day SIA window, the supplemental payment simultaneously. The exclusion criteria carry operational significance: a level-of-care transition to GIP, CHC, or respite in the final three days removes the stay from the HVLDL denominator and also ends SIA eligibility for those days, so care-transition decisions near death carry paired quality and revenue consequences. Claims that do not substantiate visit discipline, date, and time cannot support either metric.
The day of death, the day before death, and two days before death (CMS HVLDL measure specifications)[1].
No, only in-person visits by a registered nurse or a medical social worker are counted (CMS HVLDL measure specifications)[1].
Because the patient received CHC, respite, or GIP in the final three days, was enrolled fewer than three days, or did not die while on the hospice benefit (CMS HVLDL measure specifications)[1].
Vitalis Care is the end-of-life care app that helps hospices deliver compassionate care — while staying on top of schedules, field operations, documentation, compliance, and reimbursement.
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