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Hospice Billing Services
A hospice is paid per day at one of four levels of care, but only from the day a timely Notice of Election is on file. The NOE is due within 5 calendar days of the election; days before a late NOE is accepted are the hospice’s loss and cannot be billed to the patient. Vector Medical Billing builds the hospice cycle around that clock, the benefit periods, and the annual cap.
98%Published NCR
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Monthly claims
What hospice billing includes
Daily rates by level of care, billed monthly, inside the benefit period and cap rules.
Medicare hospice claims are institutional claims: bill type 81X for a freestanding hospice and 82X for a hospital-based one, billed monthly in arrears. Each day carries a level of care revenue code: routine home care (0651), continuous home care (0652), inpatient respite care (0655), or general inpatient care (0656). Routine home care pays a higher daily rate for days 1 to 60 than from day 61, and a service intensity add-on applies to RN and social worker visits in the last 7 days of life.
Benefit periods run 90 days, 90 days, and then an unlimited number of 60-day periods. From the third benefit period on, a hospice physician or nurse practitioner must have a face-to-face encounter with the patient no more than 30 days before each recertification. For fiscal year 2027 (October 1, 2026 to September 30, 2027), hospice rates rose 2.3%.
What the hospice fee covers
- NOE submitted and accepted within 5 calendar days of election
- Monthly claims by level of care, with the visit lines Medicare requires
- Benefit period and face-to-face tracking before each recertification
- Notices of termination or revocation when a patient leaves hospice
Where hospice revenue is lost
Hospice losses are mostly timing: a notice, an encounter, or a cap left too late.
A late Notice of Election
When the NOE is not submitted and accepted within 5 calendar days, the days from admission until it is accepted are not covered. They are provider-liable and cannot be billed to the patient.
A missed face-to-face encounter
Without a timely face-to-face encounter before the third or a later benefit period, the patient cannot be recertified and that period’s days are not payable.
Level of care the record does not support
General inpatient care is for symptoms that cannot be managed elsewhere. Continuous home care requires at least 8 hours of care in a 24-hour day, mostly nursing, during a crisis. Unsupported days are a review target.
Related care billed by others
Once a patient elects hospice, Medicare pays for care related to the terminal prognosis only through the hospice or the attending physician. Other providers’ unrelated claims need the right modifier or condition code.
Cap liability found too late
The FY 2027 aggregate cap is $36,174.75 multiplied by the beneficiaries counted for the hospice. Payments above it are repaid, so the cap is projected monthly, not at year end.
Quality reporting penalty
A hospice that misses Hospice Quality Reporting Program requirements loses 4 percentage points of its update: for FY 2027, 2.3% becomes a 1.7% cut. HOPE replaced the Hospice Item Set on October 1, 2025.
Hospice claim timeline
Every hospice claim depends on the notice and the certification before it.
| Event | Rule | Claim |
|---|---|---|
| Election | NOE within 5 calendar days after the election date | NOE, bill type 8XA |
| Each month of care | Claim per month, in arrears, once the NOE is accepted | 81X or 82X with level of care revenue codes and visit lines |
| Recertification | Before each benefit period; face-to-face within 30 days before the third and later periods | Certification on file before the period is billed |
| Attending physician | Billed by the attending physician on Part B; modifier GV when the physician is not employed by the hospice | CMS-1500 / 837P |
| Unrelated care | Modifier GW on Part B claims, or condition code 07 on institutional claims, for care unrelated to the terminal condition | The other provider’s claim |
| Live discharge or revocation | Notice of termination or revocation within 5 calendar days, unless the final claim is already submitted | Bill type 8XB |
| Cap year | October 1 to September 30; FY 2027 cap $36,174.75 per counted beneficiary | Self-determined cap report within 5 months after the cap year |
Hospice patients often move between settings: geriatrics · home health · hospitalist · skilled nursing.
Not inside the monthly fee
The monthly cycle bills claims that are already in the system. These are scoped on their own.
Written rate
The fee is a percentage of net collections (flat or per claim in New York). No setup fee on the monthly cycle. Month to month. The written rate follows volume, payer mix, and how much of the cycle you hand over.
See pricing or request a written rate after the free audit.
Separate work
Cap calculations for past years, ADR and medical review responses, and Medicaid room-and-board pass-through for nursing facility residents are scoped on their own.
Audit NOE timing and cap exposure
Send the census, election dates, and the last three months of claims. We report late NOEs, recertifications due, cap exposure for the year, and a written rate.
Written
Monthly rate
98%
Published NCR
50
US States
BAA
Every Client
Hospice billing questions
Straight answers for hospice agencies.
When is a hospice Notice of Election due?
Within 5 calendar days after the election date. The NOE has to be submitted to and accepted by the Medicare contractor in that window; days before a late NOE is accepted are provider-liable and cannot be billed to the patient.
What are the four levels of hospice care?
Routine home care (revenue code 0651), continuous home care (0652), inpatient respite care (0655), and general inpatient care (0656). Each day is paid at one level.
What is the hospice cap for FY 2027?
For the cap year October 1, 2026 to September 30, 2027, the aggregate cap amount is $36,174.75, multiplied by the number of beneficiaries counted for the hospice. It is the FY 2026 cap of $35,361.44 raised by the 2.3% payment update.
When is a hospice face-to-face encounter required?
Before the third benefit period and every later one. A hospice physician or nurse practitioner must see the patient no more than 30 days before the recertification.
Can the attending physician bill Medicare separately?
Yes. An attending physician who is not employed by the hospice bills professional services on Part B with modifier GV. Care unrelated to the terminal condition is billed with modifier GW.
How is the fee set?
As a percentage of net collections (flat or per claim in New York) on the book you hand over. No setup fee on the monthly cycle, month to month, with 30 days’ written notice. The written rate follows volume, payer mix, and scope.