Hospice Billing & Compliance Services
Four levels of care, NOE / NOTR, cap calculations. Our hospice billers run Routine Home Care, GIP, IRC, and Continuous Home Care claims. They file the NOE inside the 5-day window, build sequential claims, track aggregate and inpatient cap exposure, and maintain alignment with 42 CFR Part 418.
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0:48Late NOEs, cap exposure, and level-of-care miscoding eat hospice cash.
Hospice billing is built on rules other settings do not face. The Notice of Election starts the benefit. The cap closes the year. Sequential billing breaks if a single claim drops out of order. Most agencies cannot hire fast enough to keep up.
Late NOE filings cut payments
The Notice of Election (NOE) must be filed within 5 calendar days of the hospice election date (42 CFR 418.24). Late NOEs make every day before the NOE accepted date non-billable to Medicare. Most agencies lose 1 to 3 percent of revenue annually to NOE timing alone.
Cap overruns trigger repayments
Hospice has two caps: the aggregate cap (per-patient annual limit, $34,465.34 for cap year 2026) and the inpatient cap (20 percent of total days). Agencies that exceed either cap must repay Medicare. Quarterly cap monitoring is the only protection.
Level-of-care miscoding
Four levels of care (Routine Home Care, Continuous Home Care, Inpatient Respite Care, General Inpatient) each have separate per-diem rates and documentation rules under 42 CFR 418.302. One miscoded level can shift hundreds of dollars per day and trigger an audit.
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What is a hospice billing and compliance service ?
A hospice billing and compliance service is a remote billing team that works inside your hospice EMR, files the Notice of Election (NOE) within 5 calendar days of the election date, builds sequential monthly claims at the right level of care, runs the Notice of Termination or Revocation (NOTR) when a beneficiary discharges, tracks aggregate and inpatient cap exposure through the cap year, and maintains alignment with 42 CFR Part 418 conditions of participation. Not a generic offshore biller. A hospice-trained specialist who understands the four levels of care, the cap math, and the 837i transaction set for hospice claims.
What your hospice billing pod handles, day to day
Pick the queues that hurt most. Your hospice pod absorbs them. Your in-house staff focuses on clinical visits, IDG meetings, and survey readiness.
NOE submission inside 5 days
Files the Notice of Election within 5 calendar days of the election date. Tracks acceptance from the MAC. Reports any potential late filing same day.
Four levels of care billing
Bills Routine Home Care, Continuous Home Care (8-hour minimum), Inpatient Respite Care (5-day max), and General Inpatient Care at the right per-diem.
Sequential monthly claims
Builds sequential 837i institutional claims at month end. Reconciles to the clinical record. Submits before any subsequent month closes to keep the sequence valid.
Aggregate and inpatient cap
Tracks aggregate per-patient cap exposure and the 20 percent inpatient cap throughout the cap year. Flags risk before the agency exceeds either cap.
NOTR on discharge or revocation
Files the Notice of Termination or Revocation when a beneficiary discharges, revokes, dies, or transfers. Closes the claim sequence cleanly.
Payment posting and ERA
Posts ERA 835 files. Reconciles to bank deposits. Splits MA hospice carve-out balances. Flags underpayments against the contracted per-diem.
Denial management and appeals
Reads CARC and RARC codes on the 835. Drafts appeal letters for level-of-care downgrades, NOE timing denials, and certification denials.
RCM reports and KPIs
Daily NOE on-time percent, level-of-care mix, GIP percent of days, aggregate cap projection, denial rate by payer, DSO, and AR over 90.
Hospice trained billers, not generic medical coders
Most outsourcing companies offer general medical coders and call them hospice billers. We do not. Our hospice specialists are tested on the four levels of care, NOE / NOTR timing, sequential billing, and the cap math before placement.
Hospice trained, not generic
Every biller passes an assessment on the four levels of care, NOE 5-day filing window, sequential monthly claims, aggregate and inpatient cap math, and at least one platform from HCHB, MatrixCare Hospice, or Hospice Tools before placement.
Stacked compliance posture
HIPAA + SOC 2 Type II + ISO 27001 + HITRUST. Plus alignment with 42 CFR Part 418 conditions of participation and 45 CFR 164.514 de-identification rules. Ask your current vendor for proof of all four.
2-Week Risk-Free Pilot
Industry offers no trial. We give you 14 days of live hospice claim work at the same rate. Cancel before day 14, owe nothing. No annual contracts after.
Staffingly vs DIY in-house vs generic offshore vs onshore BPO
The real cost math for a single full-time hospice biller role at a mid-size hospice agency.
From "let's talk" to live in 1 to 2 weeks
Six steps. Each one is documented. Nothing is mysterious.
Discovery call (15 min)
Tell us which hospice pain is loudest. Late NOEs? Cap exposure? Level-of-care denials? NOTR mistakes? We map it on a shared call. No prep needed from you.
BAA + platform access
Business associate agreement signed. Role-based access provisioned in HCHB, MatrixCare Hospice, Hospice Tools, WellSky Hospice, or Brightree Hospice.
Workflow shadow (2 to 3 days)
Your hospice pod shadows your billing lead and IDG team. NOE cadence captured. Level-of-care review queue logged. Cap math validated.
Parallel pilot starts
Week 2 to 3. Your hospice pod runs alongside your team. Daily 15-minute sync. You see every NOE filed, every level-of-care code applied, every monthly claim built.
Decision point (end of week 2)
Pilot results reviewed. Go or no-go. No penalty if you cancel. Most agencies keep going.
Full handoff, cadence locked
NOE on-time percent, GIP percent of days, aggregate cap projection, denial rate, and AR over 90 KPIs in your inbox. Weekly review with your account lead.
How Staffingly works, in practice
Inside the workA trained Staffingly specialist works inside your existing platform, with clear escalation back to your team.
One Flat Weekly Rate. No Surprises.
Dedicated senior care schedulers at a fixed weekly cost. Per scheduler FTE, per week. No contracts, no minimums, no hidden fees.
Want to compare against an in-house hire? Use the savings calculator.
Frequently asked questions
What are the four levels of hospice care, and how do they bill differently?
Hospice has four levels of care defined under 42 CFR 418.302. Routine Home Care is the default per-diem. Continuous Home Care bills hourly during brief medical crisis requiring at least 8 hours of mostly nursing care in 24 hours. Inpatient Respite Care is a 5-day maximum stay for caregiver respite. General Inpatient Care bills a higher per-diem for symptom management that cannot be managed at home. Each level has separate documentation rules and per-diem rates.
What is the NOE, when must it be filed, and what happens if it is late?
The Notice of Election must be filed and accepted by the MAC within 5 calendar days of the hospice election date under 42 CFR 418.24. If the NOE is late, every day from the election date through the day before NOE acceptance becomes non-billable to Medicare. Late NOEs cannot be appealed except in narrow circumstances.
What is the NOTR, and when must it be filed?
The Notice of Termination or Revocation is filed when a beneficiary is discharged alive, revokes the hospice benefit, dies, or transfers. It must be filed within 5 calendar days of the discharge or revocation date. Failure to file NOTR can block future claims for that beneficiary and reject the next NOE.
How does the aggregate cap calculation work, and how do I avoid exceeding it?
The hospice aggregate cap is a per-beneficiary annual limit set by CMS. For cap year 2026 the cap amount is $34,465.34 per Medicare beneficiary. Total Medicare reimbursement during the cap year (October 1 through September 30) is compared to the cap amount multiplied by beneficiaries proportionally attributed to the agency. Amounts over the cap must be repaid. Quarterly cap projection is the only way to avoid surprise repayment.
What is the difference between IRC and GIP, and when do I use each?
Inpatient Respite Care is a 5-day maximum stay per benefit period for caregiver respite when the beneficiary is medically stable. General Inpatient Care has no day limit and is for symptom management that cannot be controlled at home such as pain crisis. GIP pays a higher per-diem but requires more rigorous documentation of medical necessity and failed home management.
What are the key 42 CFR Part 418 conditions of participation we must meet?
42 CFR Part 418 conditions of participation include patient eligibility (6 months or less prognosis certified by two physicians at first benefit period), election of the hospice benefit, an interdisciplinary group (physician, nurse, social worker, counselor), a written plan of care updated every 15 days, and the four levels of care defined at 42 CFR 418.302.
How does pricing work for hospice billing?
Per hospice specialist FTE, per week. Per-skill pricing for biller, coder, AR follow-up specialist, and denial analyst roles. No setup fees. $399 Standard, $349 Volume (3 or more), $299 Enterprise (10 or more). Add or remove specialists by the week. No annual contracts.
What is included in the 2-Week Risk-Free Pilot for hospice billing?
Two weeks of live hospice billing and compliance work running in parallel with your business office. Full reporting on NOE on-time percent, level-of-care mix, GIP percent of days, aggregate cap projection, denial rate, and AR over 90 reduction. No setup fee. No penalty if you cancel before day 14.
President and CEO, Staffingly, Inc. 25+ years in IT consulting and healthcare BPO operations. One of the earliest US operators to set up an RPO/BPO delivery network in India. Leads AI-driven home care workflows that help agencies, home health providers, and multi-branch operators cut admin cost without compromising care.
