Hospice care is a unique and compassionate service that supports patients in the final stages of life. It focuses on comfort, dignity, and quality of life, rather than curative treatment. Hospice services include skilled nursing, physician visits, medical social work, spiritual counseling, home health aides, drugs, and durable medical equipment (DME).

Billing for hospice, however, comes with significant complexity. With Medicare being the primary payer, there are strict requirements regarding benefit periods, certifications, levels of care, and timely documentation. Delays or errors in hospice billing can lead to claim denials and revenue loss.

At Progressive RCM, we specialize in end-to-end hospice billing services, ensuring that hospice agencies are paid promptly, stay compliant, and can continue delivering compassionate care to their patients.

---

Common Hospice Billing Challenges

1. Medicare Regulations & Compliance

Hospice care is governed under Medicare Part A, which comes with highly specific requirements such as:

• Election of benefit forms

• Face-to-face encounters (F2F) for recertification

• Certification of terminal illness (CTI)

• Timely claim submission per benefit period

Missing any documentation or submitting late may result in automatic denials.

2. Levels of Hospice Care

Hospice care is categorized into four levels, each with its own billing rules:

• Routine Home Care (RHC)

• Continuous Home Care (CHC)

• Inpatient Respite Care (IRC)

• General Inpatient Care (GIP)

Billing must match the level of care provided, supported by proper documentation and daily logs.

3. Benefit Period Management

Hospice patients go through two 90-day periods followed by unlimited 60-day periods. Each requires proper certification and recertification timelines that directly impact billing.

4. Room & Board Billing

In nursing home settings, hospice agencies may bill for room and board under Medicaid. This requires coordination with long-term care facilities and accurate state Medicaid claims.

5. Non-Covered Services

Certain treatments and visits may not be covered under hospice once the benefit is elected (e.g., curative services). Proper modifier use and understanding of coverage limitations are crucial.

---

CPT, HCPCS, and Revenue Codes in Hospice Billing

✅ Revenue Codes:

• 0651 – Routine Home Care

• 0652 – Continuous Home Care

• 0655 – Inpatient Respite Care

• 0656 – General Inpatient Care

• 0657 – Physician Services

• 0001 – Total charges

✅ HCPCS Codes:

• Q5001 – Hospice care in patient’s home

• Q5002 – Hospice care in assisted living

• Q5006 – Hospice care in inpatient facility

• G0182 – Physician oversight of hospice care

• A9279 – Monitoring feature, stand-alone or integrated

✅ ICD-10 Examples:

• C25.9 – Pancreatic cancer

• G30.9 – Alzheimer’s disease

• I50.9 – Congestive heart failure

• J44.9 – COPD

• C34.90 – Lung cancer

• Z51.5 – Palliative care

---

Our Hospice Billing Services

At Progressive RCM, we understand that hospice care is emotional and delicate. That’s why our billing is efficient, accurate, and respectful of regulations and timelines.

✅ Eligibility Verification

• Confirm Medicare Part A eligibility

• Check Medicaid coverage for dual-eligible patients

• Determine prior hospice benefit usage across providers

✅ Benefit Election & Certification Tracking

• Assist in gathering Election of Benefit (EOB) forms

• Track initial certification and recertification dates

• Ensure Face-to-Face (F2F) visits are completed and documented

✅ Hospice Coding and Charge Capture

• Assign correct revenue and HCPCS codes per level of care

• Apply modifiers for non-hospice services or attending physician care

• Review nursing, therapy, and aide visit logs for accuracy

✅ Timely Claims Submission

• Submit clean claims for each billing period (per 30-day or 60-day cycle)

• Integrate with EMR or hospice software (e.g., Homecare Homebase, MatrixCare)

• Validate payer-specific rules for claim format

✅ Denial Management & Appeals

• Identify causes of claim denials: late CTI, incorrect level of care, missing F2F

• Correct and resubmit within timely filing limits

• Prepare and submit detailed appeals as necessary

✅ Medicaid Room & Board Billing

• Coordinate with facilities for daily census logs

• Generate state-compliant claims for R&B

• Handle retroactive Medicaid eligibility billing

✅ Patient & Family Communication

• Provide clear patient statements (if applicable)

• Support bereavement-related billing questions

• Offer compassionate guidance for family members handling billing

✅ Monthly Reporting & Compliance Support

• Reports for revenue per patient, claim status, AR aging

• Track CTI/F2F compliance

• Prepare for CMS or MAC audits with clean documentation

---

Why Choose Progressive RCM for Hospice Billing?

✅ Medicare Experts
We are well-versed in CMS hospice billing regulations, benefit periods, recertifications, and the PDGM transition impacts on hospice care.

✅ F2F & CTI Tracking Systems
Our team tracks certification deadlines and ensures supporting documents are submitted on time — preventing denials.

✅ Integrated with Leading Hospice Software
Whether you use Homecare Homebase, MatrixCare, AlayaCare, or another EMR, we integrate and manage your claims efficiently.

✅ Complete Medicaid Coordination
We handle room and board billing, secondary claims, and retroactive eligibility billing for Medicaid-covered patients.

✅ Compassionate Financial Communication
Our billing specialists understand the sensitivity of hospice situations and interact with patients’ families with empathy and professionalism.

---

KPIs We Monitor for Hospice Agencies

• First-pass claim acceptance rate

• Claim denial rate by reason

• CTI and F2F compliance percentage

• AR days by payer

• Revenue per patient per day

• Timely NOE and NOCE filings

• Missed billing opportunity reports

---

SEO Keywords Used:

• hospice billing services

• Medicare hospice claims

• hospice revenue codes

• hospice EMR billing integration

• hospice room and board Medicaid

• hospice CTI and F2F tracking

• palliative care billing support

• billing for routine home care

• hospice denial management

• medical billing for hospice providers

---

Final Thoughts

Hospice care is about compassion — and so is our billing approach. At Progressive RCM, we ensure every claim reflects the care you’ve delivered with dignity. Our team helps you stay compliant, profitable, and focused on patients, not paperwork.