Hospice Billing Services by Prospect Healthcare Solutions
Hospice billing services cover the claims, denials and payments for hospice programs, including election notices, daily rates and benefit periods. Prospect Healthcare Solutions handles deadlines, level of care billing and follow-up, so your team can focus on patients and families.
We support hospice programs across the United States from our office in North Smithfield, Rhode Island. If late notices or eligibility issues are slowing your cash flow, start with a free review of your billing.
Prefer to talk? Call +1 (469) 935-4617.
Why Hospice Billing Needs Special Expertise
Hospice is paid by daily rate and level of care, with strict rules on election, certification and notices. Medicare also limits payment through annual caps. Because the benefit depends on timely paperwork, one late notice or missing certification can affect many days of care.
Hospice Payer Rules We Manage
These are the hospice-specific rules our revenue cycle management team checks on every claim. Rules vary by payer and change often, so we confirm each one against current payer policy.
Notice of Election
What it means: The NOE generally must be filed within 5 calendar days of election, or payment for some days can be lost.
How we handle it: We track deadlines and confirm acceptance.
Election statement
What it means: The patient or representative must sign an election with required content.
How we handle it: We review forms before billing.
Benefit periods
What it means: Medicare uses two 90-day periods, then unlimited 60-day periods.
How we handle it: We track each period and recertification date.
Face-to-face before the third period
What it means: A face-to-face encounter is required before recertifying for the third period and each later one.
How we handle it: We confirm documentation and timing.
Levels of care
What it means: Routine, continuous, inpatient respite and general inpatient care have different rates and rules.
How we handle it: We match each day to the documented level.
Cap and related services
What it means: Hospice caps apply, and unrelated services may be billed by others with specific modifiers.
How we handle it: We report cap exposure and review related claims.
Our Complete Hospice Billing Services
We manage the full hospice revenue cycle, from registration and benefit checks to final payment.
1. Eligibility and Authorization Verification
At admission we verify hospice benefit status, plan details and prior benefit periods. Learn more about insurance eligibility verification.
2. Hospice Coding and Documentation Review
Certified coders review terminal and related diagnoses, levels of care and supporting records. See our medical coding services.
3. Clean Claim Submission and Follow-Up
Every claim is checked before submission, then tracked with the payer until it is paid, so nothing is forgotten or left unpaid.
4. Denial Management and Appeals
Every denial is worked through root cause analysis, corrected claims and appeals with supporting records. See our denial management solutions.
5. Payment Posting and Patient Billing
We post and reconcile payments, send clear patient statements, and follow up on balances. Read about our accounts receivable services.
Common Hospice Denials and How We Fix Them
Example: a claim rejected for missing information
The denial. A hospice claim is denied with CARC 16 (claim lacks information) because a required election or certification detail is missing.
How we fix it: We locate the record, correct the claim and resubmit.
Example: days denied on eligibility review
The denial. Days are denied with CARC 50 (not deemed a medical necessity).
How we fix it: We appeal with the certification, physician narrative and clinical notes.
Specialized Hospice Billing Services
Routine Home Care
We bill daily care with visits and location details checked.
Inpatient and Continuous Care
We bill general inpatient, respite and continuous care with level support.
Medicaid and Room and Board
We bill Medicaid hospice and nursing facility issues under state rules. See our home health billing services for related care.
Hospice CPT Codes, HCPCS Codes and Modifiers
These are common hospice codes and modifiers we work with. Examples only: coverage and payment vary by payer, so we confirm each one before billing.
| Description | Billing note | |
|---|---|---|
| 0651 | Routine home care | Revenue code |
| 0652 | Continuous home care | Revenue code |
| 0655 | Inpatient respite care | Revenue code |
| 0656 | General inpatient care | Revenue code |
| Q5001 | Hospice care at home | Location code |
| Q5002 | Hospice care in assisted living | Location code |
| Q5003 | Hospice in nursing facility | Location code |
| GV | Attending physician not employed by hospice | Physician claim |
| GW | Service unrelated to terminal condition | Physician claim |
| Type of bill 81X | Hospice claim, non-hospital based | Institutional claim |
Why Outsource Hospice Billing?
Hospice billing takes specialized knowledge and steady follow-up. Outsourcing to Prospect Healthcare Solutions gives you:
- Lower overhead than a full in-house billing team
- Notice and benefit period tracking
- Cap monitoring support
- Faster follow-up on unpaid claims
- Clear reporting for your owners and managers
Hospice Billing Compliance
We follow HIPAA, CMS and payer rules to reduce your audit risk and build compliance into every step:
- Election statements on file
- Certifications signed on time
- Face-to-face documented
- Level of care documented
- Secure handling of patient information
Who We Serve
Our hospice billing services support:
- Non-profit and for-profit hospices
- Hospital-based hospice programs
- Multi-location hospices
- Palliative care teams linked to hospice
We work with providers nationwide, with office support in North Smithfield, Rhode Island. Find your area on our locations page.
Technology and Reporting for Hospice Billing
We use billing analytics to catch problems early and keep you informed:
- Real-time claim tracking
- Denial patterns by payer and code
- Benefit period and cap reports
- Aging accounts receivable reports
- Regular performance reviews
Hospice Billing FAQs
What are hospice billing services?
They cover notices, claims, denial management, payment posting and reporting for hospice programs.
What is a Notice of Election?
It tells Medicare a patient has elected hospice, and it has a filing deadline.
How long are hospice benefit periods?
Medicare uses two 90-day periods, then unlimited 60-day periods.
What are the hospice levels of care?
Routine home care, continuous home care, inpatient respite care and general inpatient care.
What is the hospice cap?
It is a Medicare limit on hospice payments, and it includes an aggregate cap.
How do I get a quote for hospice billing?
Request a free billing quote online or call +1 (469) 935-4617. We review your current billing and send a plan and pricing.
Partner with Experts in Hospice Billing Services
Billing should not distract you from caring for patients and families. We handle the coding, claims, denials and compliance so your hospice gets paid accurately and on time.