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Hospice Billing Services: Timely Filings, Correct Levels of Care
Elections, Benefit Periods, Caps and Physician Claims
Hospice billing runs on strict deadlines and Medicare rules that leave little room for error. A late Notice of Election, a missing face-to-face encounter or the wrong level of care can turn covered days into unpaid days. Billing Benefit handles hospice claims from election to final bill, so your team can stay focused on patients and families.
Common Hospice Billing Problems We Fix
| Billing problem | Why it costs you | How we fix it |
|---|---|---|
| Late Notice of Election (NOE) | Days before a late NOE is filed are generally not paid by Medicare | We track every admission and file the NOE within the 5-day window |
| Missing face-to-face encounter | Recertification for the third benefit period and later is not valid without it | We flag upcoming third-period recertifications well before the deadline |
| Wrong level of care or revenue code | Routine, continuous, respite and general inpatient care pay very differently | We match each day to the documentation and the correct revenue code (0651-0656) |
| Physician claims without GV or GW | Part B claims for hospice patients deny without the right modifier | We add GV for attending physician services and GW for unrelated conditions |
| Getting close to the aggregate cap | Payments over the cap must be paid back to Medicare | We monitor cap exposure during the year so there are no surprises |
Hospice Rules and Codes We Handle
From election to final claim
We file Notices of Election and Notices of Termination or Revocation on time, track 90- and 60-day benefit periods, and make sure certifications and face-to-face encounters are in place. We bill routine home care at the correct day 1-60 and day 61+ rates, add Service Intensity Add-on visits in the last days of life, and code continuous home care, respite and general inpatient days to the right revenue codes on the UB-04.
How We Keep Hospice Claims Clean
Accurate claims, fewer surprises
Before each monthly claim goes out, we check election dates, attending physician details, visit counts and levels of care against your clinical records. When a claim comes back, our denial management team works it quickly, and we keep your Medicare enrollment and payer contracts current through our credentialing services.
Compliance Watch-Outs for Hospices
Protect your Medicare payments
Hospices that do not submit required quality data face a 4 percentage-point cut to their annual payment update, and the aggregate and inpatient caps can create repayment liabilities. We help you watch both, keep documentation audit-ready, and make sure community physicians bill correctly with GV and GW modifiers for hospice patients.
Why Hospices Choose Billing Benefit
A billing team that knows hospice
You get billers who understand the hospice benefit, clear monthly reports on claims, payments and cap exposure, and one point of contact. Want to see where your hospice is losing revenue? Start with a free medical billing audit, or see all the specialties we bill for.
Hospice Billing FAQs
How long do hospices have to file a Notice of Election?
The NOE must be filed and accepted by the Medicare contractor within 5 calendar days after the effective date of the election. If it is late, Medicare generally does not pay for the days from the election until the NOE is filed, unless an exception applies.
When is a face-to-face encounter required?
A hospice physician or nurse practitioner must see the patient no more than 30 days before the start of the third benefit period, and before every benefit period after that. The findings must support the recertification.
What are the GV and GW modifiers?
Physicians use GV when the attending physician, who is not employed or paid by the hospice, bills for care related to the terminal illness, and GW when a service is not related to the terminal condition. Without them, Part B claims for hospice patients are usually denied. Read more about the GV modifier.
Do you bill Medicaid and private insurance for hospice too?
Yes. We bill Medicare, Medicaid and commercial plans, follow each payer’s authorization rules, and track room and board arrangements for patients who live in nursing facilities.
Not Sure Where Your Revenue Is Leaking?
Get a free, no-obligation medical billing audit. We review your claims, denials and A/R, then show you what to fix first.
