Best Medical Billing Companies for Hospice 

Key Takeaways 

• Hospice billing runs on per diem payments across four levels of care, which makes it very different from fee-for-service physician billing. 

• A late Notice of Election is one of the most expensive hospice billing mistakes. Days before the hospice files the NOE, the hospice becomes financially responsible. 

• For FY 2027, which began October 1, 2026, CMS finalized a 2.3% payment update and a hospice aggregate cap of $36,174.75 per beneficiary. 

• Hospices that miss quality reporting requirements lose four percentage points, turning the FY 2027 update into a 1.7% cut. 

• The FY 2027 rule also requires the election statement addendum for every beneficiary and introduces the Service and Spending Variation Index, which increases the importance of clean, well-documented claims. 

• The best medical billing companies for hospice know NOE and NOTR timing, benefit period tracking, cap monitoring, and hospice-specific EMRs, not just general claims submission. 

• Many general billing companies list hospice as a specialty. Ask for hospice client references before signing. 

Finding the best medical billing company for hospice starts with one uncomfortable fact: most billing firms are built for physician offices, and hospice doesn’t bill like a physician office. CPT-driven visit claims aren’t at the center of the revenue cycle. Instead, they charge daily rates, send warnings that must be filed by a certain date, track benefit times, and operate under an annual payment cap that can mean getting money back months after it was paid.  

That’s why choosing the right billing partner matters more than in most other fields. This guide explains how hospice billing works, what makes a good partner different from a bad one, and lists ten companies to consider. 

What Is Hospice Medical Billing? 

As a hospice nurse, you send claims for end-of-life care to Medicare, Medicaid, and other commercial payers. Hospices don’t get paid extra for each nurse’s visit or supply. Instead, Medicare pays a daily rate based on the amount of care provided that day. 

There are 4 types of care. For routine home care, they get paid two different amounts: more on days 1 through 60 and less after day 61. When there is an emergency, continuous home care is paid by the hour, and there must be at least eight hours of mostly nursing care in a 24-hour period. Inpatient respite care can last for up to five days in a row to give family workers a break. Short-term pain management that can’t be done at home is part of general inpatient care.  

Hospice bills must be sent in the institutional claim format UB-04 or its electronic 837I equivalent, and they must be paid in the right order. A claim can’t be processed until the previous month’s claim for that patient has been approved. 

Why Hospice Billing Requires Specialized Expertise 

Time rules determine how much hospice makes. You have five calendar days after the election date to file the Notice of Election. If you file late, the hospice will pay every day from admission until you file. The Notice of Termination or Revocation has the same five-day window when a patient is released, or the benefit is taken away.  

Benefit periods add another layer. Patients start with two 90-day periods, and then they can have as many 60-day periods as they want. A face-to-face meeting must be recorded before the third benefit period and every time after that. The FY 2027 final rule makes telehealth available for renewal visits until December 31, 2027. However, when telehealth is used, the claim must now include certain modifiers or numbers. 

The cap comes next. CMS caps the amount of hospice care each recipient can get each year. It went up from $35,361.44 in FY 2026 to $36,174.75 for the 2027 cap year. Hospices with long stays can exceed it and must repay the amount, which is why cap projections should happen monthly, not just at year-end. 

Common Hospice Billing Challenges 

The list starts with late NOEs. Most of the time, they’re caused by delays in admissions, missing medical qualifications, or problems with EMR sync, and you can’t recover the lost days. 

The second problem is billing order. Because of a single unpaid claim for October, that patient can’t get paid in November or December. Even a small rejection can stop months of income.  

A third type of denial comes from level-of-care documentation. Inspectors closely review continuous home care and general hospital days and expect notes that clearly explain why each day’s higher rate was charged. 

Room and board make things more difficult for people who live in nursing homes, especially those who are dual-eligible. The hospice bills Medicaid for room and board and then gets paid by Medicaid. If Medicaid is late, it directly affects the hospice’s cash flow. 

Now that quality reporting is done, payment goes straight through. The Hospice Item Set was replaced by the HOPE assessment on October 1, 2025. Hospices that don’t meet the reporting requirements will lose four percentage points. 

What Services Should a Hospice Billing Company Provide? 

Eligibility verification. Confirm eligibility for Medicare, check whether they already have a hospice plan with another provider, and verify Medicaid or private coverage before admission. 

Claims submission. Send institutional claims monthly, including the correct payment type, income numbers, level-of-care days, and service-intensity add-on visits as needed. 

Hospice-specific coding. Correctly recorded principal and linked diagnoses, because an unclear or nonspecific terminal diagnosis calls for medical review. 

Payment posting. File 835 transfers and compare per diem payments to predicted rates, including wage index changes. 

Denial management. Working quickly on denials and rejections, especially those related to the NOE date, face-to-face documentation, or level of care. 

A/R follow-up. Follow-up once a week so that claims don’t get stuck behind one problem claim. 

Payer follow-up. Working with Medicaid hospice benefits and room and board claims, which are handled differently than Medicare rules. 

Reporting and analytics. Cap forecasts, changes in length of stay, level-of-care mix, and days in A/R are all recorded every month. 

How to Choose a Hospice Medical Billing Company 

Hospice experience matters more than financial experience at the start. Find out how many hospice patients the company supports, and ask to speak with one of them.. If your business mostly bills doctor’s offices, you might not notice a sequential billing freeze until it costs you two months of money. 

Ask about the processes for NOE and NOTR in particular. Who files them, how quickly after being admitted, and how does the company know if a report was missed? Ask how they plan to show the overall hospital caps and how often they will do that. 

Questions the Best Medical Billing Companies for Hospice Should Answer Easily 

Make sure they work in your EMR. Hospices often use platforms like WellSky, Axxess, HCHB, or MatrixCare. If your billing team has to learn your system for free, it will take longer to get things done. 

10 Best Medical Billing Companies for Hospice 

We evaluated these firms based on their experience with hospice-related issues like knowing how to bill for per diem and institutional care, their service model, and how well they fit with different agency sizes. Hospice services vary from one to the next, so check with each one directly to see who their hospice clients are. 

1. Credex Healthcare

Credex Healthcare assigns one billing specialist to each hospice account, so the person processing your claims always knows your patients, the types of payers you work with, and your monthly cap position. From entry, we track NOE and NOTR timing. We review claims in order so one rejection doesn’t stop payments for months, and we check level-of-care paperwork before sending claims.   

Credex Healthcare also enrolls and certifies providers in-house, which helps hospices add a new medical director or nurse practitioner and ensure they are registered before their services show up on a claim. Monthly reports break down collections, denials by cause, and cap exposure in plain numbers. 

2. Transcure

Transcure supports the revenue cycle for many medical specialties. Their services include billing, coding, accounts receivable follow-up, and credentialing. For hospices, the most important thing to know is how many of their staff work on institutional per diem claims instead of professional claims. 

3. BillingParadise

BillingParadise offers outsourced RCM with support teams in other countries, which can help agencies with steady claim volume save money. Find out which hospice EMRs the team already works in and who is in charge of filing time-sensitive NOEs. 

4. P3 Healthcare Solutions

P3 Healthcare Solutions helps practices and facilities with billing, coding, and getting credentialed. Hospices should ask the company to show them cases of cap reporting and how they handle sequential billing holds. 

5. Revele (Formerly GroupOne Health Source)

Revele (formerly GroupOne Health Source) helps healthcare organizations with their revenue cycle by doing things like filing, paying, and managing their accounts receivable. It might work for bigger hospices or groups that offer hospice care along with other services. 

6. Integra Global Solutions

Integra Global Solutions has teams working abroad to help with medical bills and back-office tasks. That model can work for hospices with a strong in-house billing lead that need more people to post and follow up on claims. 

7. MedKloud Billing

MedKloud Billing offers billing and RCM services that are specific to certain fields. Check with the hospice’s contacts and make sure they have experience paying Medicaid for room and board in your state. 

8. Hamly Business Solutions

Hamly Business Solutions is an overseas RCM company that does A/R, billing, and coding. Find out how NOEs are handled when intake paperwork is late to see whether it fits hospice scheduling rules. 

9. MyOutDesk

Instead of a fully controlled billing service, MyOutDesk offers specialized online staff, such as billing helpers. Hospices that already have a skilled financial manager and need extra help will be able to use it. 

10. TaskUs

TaskUs is a big company that helps healthcare processes run smoothly. Because of its size, it is more useful for big hospice groups with multiple locations than for small groups with only one location. 

What to Compare When Choosing a Hospice Billing Company 

Company	Service Model	Best Fit	Ask Specifically About
Credex Healthcare	Dedicated specialist, full RCM plus credentialing	Agencies wanting one owner for billing and enrollment	Cap projection reports and NOE tracking
Transcure	Multi-specialty RCM	Agencies wanting a broad RCM vendor	Hospice-specific team size
BillingParadise	Offshore-supported RCM	Cost-conscious agencies with steady volume	EMR experience
P3 Healthcare Solutions	Billing, coding, credentialing	Agencies needing billing plus enrollment	Sequential billing holds
GroupOne Health Source	RCM services	Larger or multi-service organizations	Hospice client references
Integra Global Solutions	Offshore billing support	Agencies with in-house billing leadership	NOE escalation
MedKloud Billing	Specialty billing and RCM	Small to mid-size agencies	Medicaid room and board
Hamly Business Solutions	Offshore RCM	Agencies focused on cost	Hospice timing workflows
MyOutDesk	Remote staffing	Agencies with an experienced billing manager	Staff training in hospice
TaskUs	Large-scale outsourcing	Enterprise hospice organizations	Minimum volume requirements

In-House vs. Outsourced Hospice Billing 

With in-house billing, a hospice has direct control over the billing process and can quickly communicate with intake, clinical, and billing staff. When the company has a backup and a skilled hospice biller, it works well. The risk is getting too focused. When your hospice biller leaves, it can take weeks for NOEs and sequential claims to catch up. 

When you outsource, you spread the risk across a team and get cap and compliance knowledge that is hard to get on your own. Coordination is the price to pay. Your intake team must still send election statements, certifications, and face-to-face documentation quickly to the billing partner. The five-day NOE clock doesn’t stop for handoffs.  

Many hospices choose a mix of an internal intake and compliance lead and an outside billing team. 

How Much Does Hospice Medical Billing Cost? 

There are three main ways that prices are set. The most common way to collect is as a percentage. Because hospice per diem payments are worth a lot of money, even a one-point difference in the rate adds up over a year. For groups with a steady census, a flat monthly fee works. With staffing models like dedicated remote billers, you pay per person instead of per claim. 

Find out what’s included. It can cost extra to file NOE and NOTR, bill Medicaid for room and board, record caps, and get credentials. Write down the whole picture. 

A Real-World Example: The Cost of One Late NOE 

A person decides to go to hospice on a Monday. Because of a lack of staff, the NOE isn’t filed until the tenth day of care, when it should have been filed within five calendar days. Medicare regulations state that hospice is responsible for the days between the patient’s arrival and the date the NOE is filed. 

At the national routine home care rate of $230.83 for days 1 through 60 in FY 2026, before wage index adjustments, those nine days would have cost about $2,077. That is for a single person. If you make the mistake a few times a month as the count grows, the loss gets very expensive. It can’t happen if you have a billing partner who checks every entry against the five-day clock. 

FAQs 

What does a hospice billing company do?  

It verifies eligibility, files NOEs and NOTRs, submits sequential per diem claims, posts payments, handles denials, and tracks cap exposure. 

How is hospice billing different from regular medical billing?  

If you are a professional, hospice bills daily rates based on the level of care you need for institutional claims, but not for individual services. 

What happens if a hospice files the NOE late?  

Unless there is an exception, the hospice is responsible for paying for the days before the NOE was made. 

What is the hospice cap for FY 2027?  

The most each person can get in the 2027 cap year is $36,174.75. 

Should a small hospice outsource billing?  

Yes, especially if it only has one biller. Staff turnover is less likely to cause missed filings when you outsource. 

How much do hospice billing services cost?  

Most of them charge a flat monthly fee or a share of what they get paid. Prices change, so don’t compare price alone; look at the full scope. 

Final Thoughts 

The best hospice medical billing companies know that timing is everything when it comes to hospice income. They know about five-day NOE windows, sequential claims, benefit period recertifications, and a cap that is figured a long time after care stops. Hospice experience is more important than price.