Hospice Eligibility & Certification Services
Clean initial certifications, on-time signatures, NOE filed within 5 days. Hospice support specialists prepare 42 CFR 418.22 certification packets, schedule the face-to-face encounter, track attending physician and hospice medical director signatures, and file the Notice of Election with the MAC. 800+ providers trust us. Pilot in 2 weeks.
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0:48Late physician signatures, missed F2F encounters, and NOE filing delays cost real billable days .
Hospice eligibility paperwork is unforgiving. A signature one day late or a Notice of Election filed past five days can trigger an unbillable benefit period. Three failure modes drive most of the loss.
6-month prognosis certification gaps
42 CFR 418.22 requires written certification of terminal illness with a prognosis of 6 months or less. Missing supporting documentation or a late attending physician signature can make the entire benefit period unbillable.
Face-to-face encounter misses
42 CFR 418.22(a)(4) requires a face-to-face encounter for the third and later benefit periods within 30 days before recertification. A missed F2F means the recert is invalid.
Late NOE filing past 5 days
The Notice of Election must be filed with the MAC within 5 calendar days of hospice election. Late NOE filings shift the financial start date and reduce payable days for that election period.
Tell us about your agency.
Send us your situation and our team will scope the right setup, usually within one business day. No obligation.
What is a hospice eligibility and certification support service?
A hospice eligibility and certification support service is a remote BPO team that prepares your 42 CFR 418.22 certification packets, tracks the face-to-face encounter for the third benefit period and beyond, secures the attending physician and hospice medical director signatures, and files the Notice of Election with your Medicare Administrative Contractor within the 5-day window.
What your hospice eligibility specialist handles, day to day
Pick the certification queues that hurt most. Your hospice eligibility support staff absorbs them. Your RN case managers, intake coordinators, and medical director focus on patients and families.
Initial certification packets
Prepares the 42 CFR 418.22 written certification of terminal illness. Pulls supporting clinical documentation. Tracks attending physician and hospice medical director signatures.
Attending and hospice medical director sign-off
Secures both required signatures within the certification window. Sends reminders. Confirms each signature reaches the chart before the benefit period begins.
Face-to-face encounter scheduling
Schedules the 42 CFR 418.22(a)(4) face-to-face encounter for the third and later benefit periods. Confirms the visit within the 30-day window.
F2F attestation capture
Captures the face-to-face attestation from the hospice physician or hospice nurse practitioner. Files the attestation in the chart with the recertification packet.
NOE filing within 5 days
Files the Notice of Election with the Medicare Administrative Contractor within the 5 calendar day window. Tracks the FISS confirmation. Flags any late-filing risk.
Benefit period tracking
Tracks the 90-day, 90-day, then 60-day benefit period structure. Builds recertification reminders. Closes the loop with the certifying physician before each period ends.
ADR and denial response prep
Pulls clinical documentation for ADR responses. Prepares appeal packets for eligibility denials. Tracks reopening and redetermination deadlines.
Chart and audit readiness
Keeps certification documentation organized and audit-ready. Pulls packets for survey and SMRC review. Maintains a clean paper trail for each benefit period.
Hospice-trained support staff, not generic VAs
Most outsourcing companies offer call-center agents and call them "hospice support." We do not. Our hospice eligibility specialists are trained on 42 CFR 418.22, NOE filing rules, face-to-face encounter requirements, and the sensitivity of end-of-life conversations before they ever touch a live patient chart.
Hospice trained, not generic
Every hospice support specialist passes an assessment on 42 CFR Part 418 Conditions of Participation, eligibility criteria, IDG composition, face-to-face encounter rules, and at least one major platform from HCHB, MatrixCare Hospice, WellSky Hospice, or KanTime Hospice before placement.
Stacked compliance posture
HIPAA + SOC 2 Type II + ISO 27001 + HITRUST. Plus alignment with 42 CFR Part 418, HQRP submission deadlines, and CAHPS Hospice survey requirements. Ask your current vendor for proof of all four. We will wait.
2-Week Risk-Free Pilot
Industry offers no trial. We give you 14 days of live hospice support work at the same rate. Cancel before day 14, owe nothing. No annual contracts after.
Staffingly vs DIY in-house vs generic VA vs onshore BPO
The real cost math for a single full-time hospice eligibility and certification FTE 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 certification queue is loudest. Initial certs? Recerts? NOE filing? F2F scheduling? 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, Suncoast, WellSky Hospice, KanTime Hospice, or Netsmart.
Workflow shadow (2 to 3 days)
Your hospice eligibility team shadows your intake coordinator and medical director workflow. Signature routes captured. Tone matched. Escalation rules locked.
Parallel pilot starts
Week 2 to 3. Your eligibility specialist runs alongside your team. Daily 15-minute sync. You see every certification packet, every F2F entry, every NOE filed.
Decision point (end of week 2)
Pilot results reviewed. Go or no-go. No penalty if you cancel. Most hospice agencies keep going.
Full handoff, cadence locked
Certification-on-time and NOE-on-time KPIs in your inbox. Weekly review with your account lead. Monthly QA audit. Expansion paths discussed.
How your hospice support specialist's day actually looks
A real shift, hour by hour. Times shown in your local time. We rotate coverage so your certification queue is never dark during business hours.
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 does 42 CFR 418.22 require for hospice certification?
42 CFR 418.22 requires written certification that the patient is terminally ill with a life expectancy of 6 months or less if the illness runs its normal course. The initial certification must be signed by both the hospice medical director (or designee) and the attending physician (if one exists). Our hospice support team prepares the packet, pulls clinical documentation, and tracks both signatures.
What is the face-to-face encounter requirement under 42 CFR 418.22(a)(4)?
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, and the F2F provider must attest in writing. Our team schedules the visit, confirms the timing, and files the attestation in the chart.
How does the 5-day NOE filing rule work?
The Notice of Election (NOE) must be filed with the Medicare Administrative Contractor within 5 calendar days of the effective hospice election date. A late NOE shifts the financial start date forward to the filing date, which means days before the file date are not payable. Our team files within the 5-day window and confirms FISS acceptance.
Who can sign the initial certification of terminal illness?
The initial certification requires signatures from the hospice medical director (or physician member of the IDG designee) and the attending physician (if the patient has one). The attending physician must be identified by the patient or representative. Recertifications require only the hospice physician signature.
How does an initial certification differ from a recertification?
The initial certification covers the first 90-day benefit period and requires two physician signatures (hospice medical director and attending). Recertifications cover the second 90-day period, then unlimited 60-day periods, and require only the hospice physician signature. From the third benefit period onward, a face-to-face encounter is also required.
How do you handle eligibility denials and ADR responses?
Our team pulls supporting clinical documentation for Additional Documentation Request (ADR) responses and prepares appeal packets for eligibility denials. We track the redetermination, reconsideration, and ALJ appeal deadlines, and maintain a clean paper trail of clinical decline indicators for each contested benefit period.
How much does hospice eligibility and certification support cost?
Standard is $399 per FTE per week for a single-site hospice agency. Volume is $349 per FTE per week for 3+ FTEs at a mid-size or multi-site operator. Enterprise is $299 per FTE per week for 10+ FTEs in a multi-state network. No setup fees. Flat weekly billing.
How does the 2-Week Risk-Free Pilot work?
Two weeks of live hospice eligibility and certification work at the same per-FTE rate. We onboard in 5 to 10 business days, run your certification queue in parallel with your team, and you see every packet, every signature, and every NOE filed. Cancel before day 14, owe nothing. No annual contracts after.
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.
