Hospice & Palliative Care Support Services

42 CFR 418.22 requires written certification of terminal illness with a life expectancy of 6 months or less if the illness runs its normal course. Our hospice support specialists prepare the initial certification packet, track signature deadlines for the medical director and the attending physician, and flag any missing documentation before billing. Each benefit period has its own certification checklist that our team maintains.

42 CFR 418.22(a)(4) requires a face-to-face encounter with a hospice physician or hospice nurse practitioner before the start of the third benefit period and before each subsequent benefit period. The encounter must occur within 30 calendar days before recertification. Our hospice support staff schedules the encounter, tracks the date, captures the attestation, and closes the loop with the certifying physician.

The first benefit period is 90 days, followed by another 90 days, then unlimited 60-day periods. The most common slip is a late physician signature on the certification or a missed face-to-face encounter for the third period or later. Our team tracks signature dates, sends reminders, and prepares the recertification packet.

42 CFR 418.56 requires the interdisciplinary group to include at least one hospice physician or medical director, a registered nurse, a social worker, and a pastoral or other counselor. The IDG must review and update the plan of care at least every 15 calendar days. Our team prepares the agenda, pulls updates from each discipline, and drafts the meeting minutes for clinical sign-off.

The hospice aggregate cap limits the total Medicare payment a hospice can receive in a cap year. The 2025 cap is approximately $34,465.34 per beneficiary. There is also an inpatient cap which limits inpatient days to 20 percent of total hospice days. Our team monitors both caps month over month and reports to clinical leadership before a cap penalty is triggered.

The CMS Hospice Quality Reporting Program (HQRP) requires hospices to submit quality data including HOPE assessment data (which replaced HIS in 2025) and CAHPS Hospice survey results. Failure to meet HQRP requirements triggers a 4-percentage-point reduction to the Annual Payment Update. Our team tracks HOPE timepoints and submits to CMS within deadlines.

Hospice has four levels of care: Routine Home Care (RHC), Continuous Home Care (CHC), Inpatient Respite Care (IRC), and General Inpatient Care (GIP). GIP is for pain control or acute symptom management that cannot be managed at home and must be documented carefully. Our team helps document the level-of-care change, files the Notice of Election (NOE) or required transitions, and tracks the 20 percent inpatient cap.

Full HIPAA-aware workflow with signed BAA, role-based platform access, and audit logging. PHI never leaves the controlled environment. Our hospice specialists work from biometric-secured facilities and are trained on the sensitivity of end-of-life conversations, family communication boundaries, and bereavement contact protocols.