Hospice Billing Service

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Hospice Care Billing Services

Hospice care providers dedicate their work to patients in their final stage of life. The care is deeply personal. But the billing side is anything but simple.

There are unique rules, codes and compliance requirements for hospice billing. One small mistake can result in denials of claims, delayed payments or audits. So many hospice providers are trying to keep up their pace, not because they aren’t skilled, but because the billing is really complicated.
We are experts in hospice billing and revenue cycle management at iFocus RCM.

We help hospice agencies get paid accurately and on time.

Common Billing Problems Hospice Providers Face

If you run a hospice agency, chances are you have experienced at least one of these problems. Many agencies face all of them.

Claim Denials Due to Statement Errors

The hospice election statement is the foundation of the Medicare hospice benefit. The patient (or their representative) must sign this document before hospice care begins. If the election statement is missing required information like the attending physician's name, the effective date, or the patient's waiver

Incorrect Revenue Codes

Hospice claims use specific revenue codes to identify the type of care provided. Using the wrong revenue code — even if the care matches the right level — causes automatic denial. Some billing systems auto-populate codes incorrectly. Others pull the wrong code when a patient transitions between care levels. How we fix this:

Late or Missing Recertification

Medicare requires recertification by the physician at certain times. This encounter must be documented by a physician or nurse practitioner. If recertification is late by even one day, Medicare can deny the entire benefit period. If the face-to-face is missing, the same applies. Many hospice agencies are losing thousands of dollars.

NOE Filing Delays

The Notice of Election (NOE) must be filed with Medicare within five days of the patient's hospice election. If filed late, Medicare will not cover care provided before the NOE was received; even if the patient was already enrolled. Some agencies do not even realize they are consistently filing late. They only discover the problem during a retrospective audit. How we fix this:

Failure to Bill Non-Covered

Hospice patients sometimes receive medications or services that are not related to their terminal diagnosis. These services are NOT covered under the hospice benefit. They should be billed to Medicare Part A or Part B separately. Many hospice agencies either miss this or do not have a system to identify non-covered services. This results in lost revenue, services provided but never billed.

Drugs and Services

By maximizing your revenue opportunities, minimizing errors through better operational efficiencies, our billing team provides you with significant medical billing ROI benefits. Your staff will work with our team closely so that we are helping each other develop processes to streamline your operations and reduce your administrative work load

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Why Hospice Billing Is Different

Hospice billing is not like standard medical billing. It operates under a unique Medicare benefit structure. It has its own revenue codes, levels of care, and election requirements.

Most general billing teams are not equipped for it. Even experienced billers make costly mistakes when they move into hospice without proper training. Here is what makes hospice billing uniquely challenging.

Many agencies use outdated templates. Others miss new CMS requirements that have been updated over the years. The 2021 election statement update added several new required elements. Agencies that did not update their forms saw widespread denials.
How we fix this:
We audit your election statement templates against current CMS guidelines. We flag missing elements before claims are submitted. We also train your intake team on what to collect and verify at the time of enrollment.

Our approach

Why Hospice Agencies Choose iFocus RCM

We are not a general medical billing company that does hospice as an aside. Hospice billing is a core specialty of ours. Our team is familiar with the Medicare hospice benefit.
Here’s what it’s like to work with us:

Hospice Billing Team Dedicated

You get billers that work only on hospice accounts. They know the revenue codes. They know the periods of benefits. They know what Medicare auditors want.

Focus on Clean Claim Rate

We want to get clean claims out on the first try. We check every claim before it goes out. We stop errors before they become denials.

Open Reporting

You always know where your cash is. We regularly report about:
• Claims reported and paid
• Denial reasons and rates
• AR ageing by payer
• Timeliness of NOE filing
• Compliance with recertification

Rapid Resolution of Denials

When a claim is denied, we move quickly. We look at the reason, collect the evidence to support it and submit the appeal, with no follow-up required on your part.

Compliance Assistance

We help you stay in compliance with Medicare rules. We identify documentation gaps, audit your billing patterns and advise you of regulatory changes that affect hospice billing.

Why

ICD-10 Coding for Hospice: A Separate Challenge

Hospice patients are difficult to code. Proper coding of the terminal diagnosis is required. Other diagnoses affecting care should be documented also.

Terminal Illness Must Be Principal Diagnosis

The terminal condition should be the primary diagnosis on a hospice claim, not a symptom or complication. It is not correct to code “dyspnea” as the principal diagnosis if the patient has end-stage COPD, for example.

Coding Updates Require Ongoing Attention

ICD-10 codes are updated every October. New codes are added. Some codes are made more specific. Codes that were valid last year may be invalid next year.

Comorbidities Should be Coded and Documented

Hospice patients often have more than one condition. These co-morbidities influence the care plan and the services required. They must be coded and supported in the clinical documentation.

How we solve this

Our coding team is up to date on all ICD-10 changes. We look at both primary and secondary diagnoses on each claim. We identify coding that is inconsistent with clinical documentation, and help your team address it before submission.

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Get Your Hospice Billing Under Control

There is no reason for hospice billing to be a continual source of stress. The right billing partner makes a real difference; in revenue, in compliance and in the time your team spends on administration.

At iFocus RCM, we manage the billing complexity so your clinical team can concentrate on patients.
Dealing with claim denials, ageing AR, missed recertification, or audit concerns?

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