Hospice billing: levels of care, election paperwork, and timely notices
Hospice is paid per day at a level of care rather than per service, so the claim is really an assertion about what level the patient required each day. Routine home care carries a rate that steps down after an initial period, continuous home care is billed hourly and requires predominantly nursing care during a crisis, inpatient respite is limited per period, and general inpatient care requires documented symptom management that could not be provided at home. Days billed at a higher level without that documentation are the single largest recoupment risk in the benefit.
The administrative requirements are just as consequential as the clinical ones. The notice of election must be filed within a short window or the days before filing are not payable, the election statement and certification must be complete and timely, and recertification requires a face-to-face encounter by the appropriate clinician within the prescribed window. Add the service intensity add-on for qualifying visits near the end of life and the site-of-service reporting for where care was delivered, and there are several independent ways for a clinically perfect episode to go unpaid. We monitor election and certification deadlines as a calendar, not as paperwork.
Coding and documentation focus
- ✓Level of care selection per day — Routine, continuous home, inpatient respite, and general inpatient care each require specific documented conditions for the days billed.
- ✓Timely notice of election — Filing outside the allowed window makes the days before filing non-payable, so the notice is tracked against the election date.
- ✓Face-to-face recertification — Recertification for later benefit periods requires a documented face-to-face encounter within the prescribed window.
- ✓Service intensity add-on and site reporting — Qualifying visits near the end of life carry an add-on payment, and the location where care was delivered must be reported.
Denials we prevent on these claims
- ✓Notice of election filed late — deadlines tracked as a calendar with daily review.
- ✓General inpatient days without documented symptom management needs — reviewed before billing.
- ✓Missing or untimely face-to-face recertification — scheduled ahead of the benefit period boundary.
- ✓Continuous home care hours unsupported by the nursing proportion required — verified against visit records.
Frequently asked questions
What makes general inpatient hospice days payable?
Documentation that the patient required pain control or acute symptom management that could not be provided in any other setting, with the interventions, the escalation, and the response recorded day by day. Convenience, caregiver availability, or facility placement alone will not support the level on review.
What happens if the notice of election is filed late?
The days from the election date until the notice is filed become non-payable, and they cannot be recovered by refiling. Because the exposure grows daily, election notices need to be tracked on a deadline calendar rather than handled as routine admission paperwork.