We treat hospice billing like clinical care: proactive, humane, and meticulous. Below are the high-value actions we add to your workflow immediately.

Intake & election validation (stop errors at the door)

We verify Part A eligibility, grab election dates, hospice site Q-codes (e.g., Q5001 for home, Q5004 for SNF), and record the physician certification and supporting materials. Clinical narration was demanded for the hospice election. Early validation avoids denials caused by enrollment and date-of-service discrepancies.

Daily level-of-care accuracy (RHC, CHC, GIP, Respite)

Medicare pays a daily rate depending on the degree of hospice care: routine home care, continuous home care, general inpatient, and respite. We reconcile clinical notes to the designated daily level, flag borderline days (e.g., sporadic continuous care), and produce supporting documentation so that the daily claim level is defensible.

Revenue & HCPCS (Q-code) mapping

Each claim is guaranteed to use the appropriate revenue center codes (e.g., 0651 Routine Home Care, 0652 Continuous Home Care, 0656 General Inpatient Care) and HCPCS/Q-codes for place-of-service. This reduces payer confusion and prevents routine rejects.

Occurrence span and condition codes (critical audit signals)

Occurrence span, admission, discharge, and condition codes are how Medicare ties payments to certification periods. We validate occurrence fields, discharge for cause, and recert dates so the payment ties back to documented clinical eligibility.

Skilled documentation & clinical tie-ins

Hospice covers palliative services — but clinical documentation must show the terminal prognosis and how services match the plan of care. We help structure documentation templates (nursing, social work, physician) that clearly support the elected level of care.

Pre-submission scrubs + human QA

Our AI pre-scrub checks for missing occurrence codes, conflicting dates, wrong revenue codes, and common hospice edit triggers. High-risk claims go to a hospice-trained coder for human review before submission.

Denial triage & appeals playbook

When denials occur (eligibility, documentation, duplicate billing), we triage, create evidence-based appeal packets, and track overturn rates. Over time we feed denial root causes back into provider prompts and intake logic so the same issue doesn’t repeat.

Patient financial empathy & outreach

Hospice families are often stressed. Our voice-first outreach scripts are empathic: we explain benefit statuses, co-insurance obligations (if any), and offer payment plans without pressure. When a conversation becomes clinical or sensitive, calls are escalated to a human specialist.