Hospice RCM

Hospice RCM: Per-Diem Billing, Levels of Care & Face-to-Face Requirements

From Notice of Election timeliness to GIP documentation and hospice cap management, our hospice-specialized team protects agency revenue while keeping compliance airtight.

99.2% NOE Timeliness Rate
17% Average Reimbursement Lift
24 Days Average Days in AR
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The Challenge

Why Hospice Billing Is Its Own Universe

Hospice is the only Medicare benefit paid per diem across four levels, capped annually, governed by recertification rules, and watched closely by OIG audits. Generic billers don't survive contact with it.

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Four Levels of Care

RHC, CHC, IRC, and GIP each pay differently and require distinct clinical documentation. We bill the right level every day based on documented triggers and clinical need.

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NOE 5-Day Deadline

Late Notice of Election means the hospice absorbs days of care cost. We submit NOEs same-day whenever possible and monitor confirmation.

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Face-to-Face Recertification

From benefit period 3 onward, physician or NPP F2F encounters are required before recertification. Missing F2F denies the period, we track every window.

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Hospice Cap Monitoring

Aggregate and inpatient caps create financial risk if exceeded. We project cap liability quarterly and advise on operational adjustments.

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Related vs. Unrelated Conditions

Related conditions fall under the per-diem; unrelated conditions can be billed separately. This distinction is an OIG audit focus, we document and defend it.

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GIP/CHC Clinical Review

High-acuity levels attract MAC and RAC audits. We review documentation daily during GIP and CHC episodes to prevent retrospective denials.

Our Approach

Hospice-Certified Billing From Election to Discharge

Our hospice RCM team includes CHC-C certified hospice coders, NHPCO-trained compliance specialists, and revenue-cycle veterans who understand CR8358, CR12257, and every transmittal shaping hospice payment.

  • Same-day NOE submission with confirmation tracking
  • Level-of-care daily documentation review for RHC, CHC, IRC, GIP
  • F2F scheduling automation with 60-day advance recertification alerts
  • Cap projection reporting quarterly with scenario modeling
  • Related/unrelated condition documentation with IDT coordination
  • ADR and denial response with clinical narrative support for MAC and RAC audits
Hospice nurse comforting patient and family
17% Average Reimbursement Lift
99.2% NOE Timeliness
94% First-Pass Resolution
24 Days Average Days in AR
Compliance & Security

HIPAA-Compliant Hospice Billing Operations

Hospice records include end-of-life clinical documentation, family communication, and sensitive IDT notes. Our operations align with HIPAA, ISO 27001, and HITRUST CSF.

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HIPAA & Hospice CoPs

All PHI lives inside encrypted, access-controlled systems with audit trails. Our team is trained on Hospice Conditions of Participation and survey-readiness documentation.

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ISO 27001 & HITRUST

Information security management aligned with ISO/IEC 27001 and HITRUST CSF. Continuous monitoring, least-privilege access, and documented incident response protect hospice data.

FAQ

Hospice Billing Questions Answered

Related Services

Billing & AR Medical Coding Denial Management Eligibility & VOB Prior Authorization
Medicare pays four hospice levels at different per-diem rates: Routine Home Care (RHC, standard in-home), Continuous Home Care (CHC, 8+ hours of predominantly nursing during crisis), Inpatient Respite Care (IRC, up to 5 days of caregiver relief), and General Inpatient Care (GIP, acute symptom management in a facility). We bill the correct level daily, document triggers and justification, and manage CHC/GIP clinical review before and during episodes.
Medicare requires NOE submission within 5 calendar days of election. Late NOEs cause the hospice to absorb the cost of care from the election date until NOE submission, a significant financial loss. We submit NOEs day-of election whenever possible and monitor confirmation to catch rejections before they become payment losses.
Starting with the third benefit period, hospice physicians or NPPs must complete a face-to-face encounter within 30 days prior to recertification, with the attestation documenting continued terminal prognosis. Missing F2F invalidates the certification and denies the subsequent period. We track every benefit period transition and schedule F2Fs proactively.
Medicare limits aggregate annual hospice payments per beneficiary (the hospice cap). Exceeding the cap requires repayment to CMS. We track each hospice's projected cap liability throughout the year, model admission and length-of-stay scenarios, and advise on admission decisions to keep the agency sustainable without sacrificing care.
Conditions related to the terminal diagnosis are covered by the hospice per-diem; unrelated conditions can be billed separately to Medicare Part A/B. The 'related vs unrelated' distinction is a major audit target. We work with IDT teams to document related/unrelated determinations clearly and bill correctly to prevent both underbilling and OIG audit risk.
Yes. GIP requires acute symptom-management documentation and a contract or direct-provision facility. CHC requires 8+ hours of predominantly skilled nursing during a crisis with prorated payment. Both levels have heightened audit risk. We review documentation daily during GIP/CHC episodes and bill precise hours to ensure accuracy.
The hospice medical director's administrative activities are bundled into the per-diem. However, physician services for direct patient care (G0299, GV, GW modifiers) can be billed separately. Attending physician services are billed by the attending, not the hospice. We manage the full stack of hospice physician billing rules.
We track both the aggregate cap (annual per-beneficiary payment limit) and the inpatient cap (percentage of days that can be GIP/IRC). Running at or near either cap requires operational adjustments. We provide quarterly cap reports with scenario planning to keep the agency compliant.
We integrate with Homecare Homebase, WellSky Hospice, MatrixCare Hospice, Axxess Hospice, Consolo, Hospice Tools, and Suncoast Solutions. Our team configures daily charge capture, level-of-care tracking, NOE submission, and cap monitoring inside your existing platform.
Related Specialties

Adjacent Post-Acute & End-of-Life Specialties

Home Health ›

PDGM, OASIS, F2F, and NOA management for home health agencies.

SNF ›

PDPM, MDS, and Medicare Part A/B coordination.

Oncology ›

Complex oncology billing, drug J-codes, and palliative-care coordination.

Hospitals ›

Facility billing, DRG management, and transitions-of-care workflows.