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Hospice Billing Services Billing & RCM Services
Hospice revenue is lost in the days and signatures around the care: a Notice of Election filed late, a certification missing its physician narrative, or end-of-life nursing visits never captured for the Service Intensity Add-on. Qualigenix bills hospice claims so the election, certification and level of care on each claim are on time and backed by the record.
how hospice practices gets paid
Medicare pays hospice a daily rate for each day of care, set by the level of care: routine home care, continuous home care, inpatient respite or general inpatient care. Payment depends on a Notice of Election filed within 5 calendar days, a valid physician certification for each benefit period, and documentation that supports a terminal prognosis. Qualigenix bills hospice claims for home-based agencies, inpatient units and hospital-affiliated programs, with a 98.6% compliance and audit pass rate. Call 786-259-0231 to review your hospice claims with our team.
01
Level of care and SIA coding
Each day is billed at one of four levels, and routine home care pays a higher rate for days 1 to 60 than for day 61 onward. The Service Intensity Add-on pays extra for registered nurse and social worker visits in the last 7 days of life during routine home care. CMS's 2025 error data lists missing SIA documentation among the top three reasons hospice claims were paid in error.
02
GIP and respite justification
General inpatient care is paid only when pain or symptoms cannot be managed in another setting, and the record has to show why. Inpatient respite is limited to 5 consecutive days per stay. Medicaid and commercial plans often require authorization before either level starts.
03
NOE and election timeliness
The Notice of Election must reach the Medicare contractor within 5 calendar days of the election date. If it is late, the days between the election and the filing date are not covered, and the hospice cannot bill the patient for them. The Notice of Termination or Revocation has the same 5-day window at discharge.
04
Certification and face-to-face timing
Every benefit period needs a written certification of terminal illness with a physician narrative, and the hospice must have it before billing. Before the third benefit period and each one after, a hospice physician or nurse practitioner must complete a face-to-face encounter in the 30 days before it starts. An inadequate certification was the second most common hospice error in CMS's 2025 data.
05
Benefit periods and the hospice cap
The Medicare hospice benefit runs in two 90-day periods followed by unlimited 60-day periods, and each transition needs its own recertification. Each hospice also has an aggregate cap on Medicare payments per cap year, and payments above it must be paid back.
06
Terminal prognosis documentation
Medical necessity was the top hospice error in CMS's 2025 data. The record has to show a prognosis of six months or less if the illness runs its normal course, with decline documented over time, especially for long-stay patients and non-cancer diagnoses.
07
Hospice denial patterns
Hospice denials and additional documentation requests usually point to a late NOE, a certification signed after the claim was submitted, a missing face-to-face note, unsupported SIA units or an eligibility conflict with another provider's claim.
08
HOPE, HQRP, and audit exposure
Since October 1, 2025, hospices report quality data through the HOPE assessment, which replaced the Hospice Item Set. A hospice that misses Hospice Quality Reporting Program requirements loses 4 percentage points from its annual payment update. Hospice is also one of four improper payment drivers CMS named for 2025, which keeps it under heavy audit attention.
PRECISION: WHAT QUALIGENIX DOES
How Qualigenix secures hospice revenue
Qualigenix closes each gap with a check built into the hospice billing cycle.
Accurate level-of-care billing
We bill each day at the level the record supports, apply the two-tier routine home care rate correctly, and capture every qualifying RN and social worker visit in the last 7 days for SIA. Qualigenix holds 98.9% coding accuracy and an over/undercoding rate under 2%.
GIP and respite documentation support
Before a GIP or respite day is billed, we check that the record states why the patient needed that level, and we track respite days so the 5-day limit is not exceeded.
NOE and NOTR filed on time
We file Notices of Election and Termination or Revocation within the 5-day window and confirm each one was accepted, so no day of care goes unbilled because of a late notice.
Certification and F2F tracking
We track each patient's benefit period dates, flag certifications that are unsigned or missing a narrative, and alert the hospice before a face-to-face encounter is due.
Benefit period and cap monitoring
We monitor benefit period transitions and the hospice's running cap position through the year, so there is no surprise repayment when the cap is calculated.
Prognosis documentation review
For long-stay and non-cancer patients, we review the chart for documented decline before each recertification and flag gaps for the clinical team to address.
Denial and ADR response
We answer additional documentation requests with complete records and appeal hospice denials by root cause. Across our book of business, 79% of appealed denials are overturned.
HQRP and audit readiness
We help hospices keep HOPE submissions and claims data in step, and keep election statements, certifications and visit notes organized for audit requests.
CASE STUDY 01
How A Home-Based Hospice Agency Recovered $133K On Level-of-Care Downgrades
THE SITUATION
General inpatient care (revenue code 0656) was billed without documentation supporting the level, so payers downgraded it to routine home care (0651), and the Service Intensity Add-On (SIA) went uncaptured.
WHAT QUALIGENIX DID
We aligned level-of-care billing to documented need, captured SIA for end-of-life visits, and reconciled per-diem days to the plan of care.
Key Outcomes & Turnaround
Audited Practice Results
How An Inpatient Hospice Facility Recovered $200K On Per-Diem Billing Backlog
THE SITUATION
Per-diem claims and notice-of-election processing aged after a staffing change, leaving benefit-period and day-count gaps and unbilled days.
WHAT QUALIGENIX DID
We cleared the backlog, reconciled benefit periods and election dates, and automated per-diem day counting.
Key Outcomes & Turnaround
Audited Practice Results
How A Hospital-Affiliated Hospice Program Recovered $216K On Certification & Authorization
THE SITUATION
Physician certification and face-to-face recertification were incomplete at billing, and high-cost interventions proceeded without approval, driving returns.
WHAT QUALIGENIX DID
We built a certification-tracking system ensuring signed documentation before billing and verified coverage for high-cost services.
Key Outcomes & Turnaround
Audited Practice Results
Hospice coding by level of care
Qualigenix bills every level of hospice care and the services that ride on the hospice claim.
Routine home care
Routine home care is the daily rate for most hospice days. It pays one rate for days 1 to 60 of a hospice stay and a lower rate from day 61.
COMPLIANCE
Keeping hospice claims audit-ready
Qualigenix keeps hospice billing compliant by billing only the days, levels of care and visits the record supports. We file Notices of Election and Termination within 5 days, confirm a signed certification with a physician narrative for every benefit period, track face-to-face encounters from the third period on, and monitor the hospice cap through the year. Underbilling leaves earned revenue unpaid, and overbilling invites recoupment and audits. Qualigenix holds a 98.6% compliance and audit pass rate with an over/undercoding rate under 2%. All work is HIPAA compliant, with patient data handled under strict security controls.
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Audit Pass Rate
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Variance Threshold
Why hospice providers choose Qualigenix
Our hospice billers work NOE deadlines, certification rules and SIA capture every day, so claims hold up when the documentation request comes. CMS's own error data shows where hospice claims fail.
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IMPROPER PAYMENT RATE
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FROM DOC GAPS
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FROM CODING ERRORS
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QUESTIONS BUYERS ASK
Frequently asked questions
Qualigenix charges a percentage of collections, so the fee moves with what your hospice is actually paid. The rate depends on census, payer mix and the services you need, and a billing specialist quotes it after reviewing your numbers.
Yes. We bill each day at the level the record supports and capture every qualifying RN and social worker visit in the last 7 days of life for the Service Intensity Add-on.
We keep election statements, certifications, face-to-face notes and visit records organized by patient, and we answer additional documentation requests with complete records inside the deadline.
Yes. We work old hospice AR by denial reason and payer, and across our clients we have reduced days in A/R from 54 to 36 with a 97.7% net collections rate.
We file each Notice of Election within 5 calendar days of the election date and confirm the contractor accepted it. A late NOE leaves every day before the filing date unpaid, so we treat it as a same-week task.
We track each patient's benefit period dates and recertification deadlines, and we monitor the hospice's aggregate cap position through the cap year to avoid a surprise repayment.
Yes. Qualigenix works inside your existing hospice EMR and has billed across 133 EMR/EHR platforms.