Skip to content Credex Healthcare provides hospice billing services for Medicare-certified hospice agencies, community-based palliative care organizations, and hospital-affiliated hospice programs dealing with level-of-care billing errors, election statement documentation gaps, and the compliance risk that comes when routine care days are billed without the clinical visit records to support them.
Credex Healthcare’s hospice insurance billing services handle the full billing cycle, from certification period management and level-of-care tracking through claim submission, denial resolution, and payment reconciliation.
First-pass claim approval rate
Average hospice billing turnaround
Medicare, Medicaid & commercial networks
Certification & election documentation management
Credex Healthcare runs a dedicated hospice billing process that reviews each claim period for election statement currency, physician certification status, level-of-care accuracy, and clinical visit documentation before any claim goes out. Hospice billing errors and fixes are costly in this specialty, not just because of denial volume, but also because of the compliance exposure that comes with billing days not supported by the required clinical records. Medicare’s hospice benefit is subject to medical review, and billing routine home care days without documented visits in the clinical record is one of the most common reasons hospice agencies face recoupment demands.
Our hospice billing services in the USA cover the following:
Claims for daily rates are submitted with confirmed level-of-care codes, up-to-date voting statements, live physician certifications for the billing period, and clinical visit records that back up the days paid. After a claim is decided, our team checks in to ensure everything is in order before the filing deadline.
We manage provider enrollment for hospice agencies with Medicare, Medicaid, and commercial carriers, including Medicare hospice provider number maintenance and state Medicaid hospice program enrollment, so your agency bills from an active, compliant enrollment status.
Denied hospice claims are reviewed within 48 hours. Whether the rejection came from an expired physician certification, a level-of-care code mismatch, a missing election statement, or a clinical documentation gap, our team corrects it and resubmits the documentation as required by the specific MAC or payer.
Our certified coders audit billing periods against hospice billing codes G0299, G0155, Q5001, Q5009, and the full hospice HCPCS code set, confirming that level-of-care assignments match the documented clinical status and that all required certification and election records are current.
Medicare hospice benefit periods require physician certifications at 90 days, 90 days, and every 60 days thereafter. We track certification renewal timelines for every patient on census and flag upcoming expirations before the certification lapses, creating an uncovered billing period.
End-to-end RCM covers patient census management, election statement tracking, certification period monitoring, level-of-care daily-rate billing, payment posting, and monthly financial reporting, ensuring that hospice administrators have accurate collections data by care level and payer each billing cycle.
As the only hospice billing company in the US, Credex Healthcare keeps up with changes to Medicare’s hospice benefit rules as CMS establishes them. We monitor changes to Medicaid’s hospice billing rules by state and keep up with the latest billing standards for all four levels of hospice care, including the billing codes and the professional service codes billed under the hospice election. Medicare hospice benefits have different rules about who can get them, how they must be certified, and how they must record their care than other home-based care programs. Hospice billing has tighter rules than most fields because the benefit is separate from all other Medicare Parts A and B coverage for people who have a terminal illness. This makes accurate paperwork both a financial and legal concern.
Medicare covers hospice care under Part A when a patient elects the hospice benefit, and two physicians certify a terminal prognosis of six months or less. We manage Medicare hospice billing across all MAC jurisdictions, applying the correct level-of-care codes, managing certification period renewals, and maintaining documentation standards that support each billed day.
Most states offer Medicaid hospice care, but the rules for benefits, payments, and obtaining prior authorization vary widely. Some state Medicaid programs require hospice candidates to obtain such approvals first. Our team stays current on Medicaid hospice billing rules in each state and ensures they are properly followed across all claims.
Commercial payers and managed care organizations that cover hospice services have their own rules about who can receive services, how much care is needed, and how to bill them. We handle commercial hospice bills separately from Medicare, making sure to use the correct codes and follow the paperwork standards required by each carrier.
The two most serious levels of hospice care are general hospital care and ongoing home care. These levels require more paperwork than regular home care. We handle GIP and CHC billing, which includes reviewing the clinical paperwork required for those higher-rate days to withstand insurance scrutiny.
Hospice claims fail and create compliance exposure for the same set of reasons: physician certifications that lapsed without renewal, election statements not updated after revocation and re-election, routine home care days billed without supporting visit documentation, and level-of-care codes that do not match the clinical record. Credex Healthcare reviews all of that before any claim is submitted.
Every hospice claim is verified against your active Medicare hospice provider number, agency NPI, and state hospice license before submission. A lapsed provider number or a mismatched billing identifier is among the fastest routes to an immediate claim rejection or a CMS compliance review.
We audit census records against Q5001 (routine home care), Q5002 (continuous home care), Q5003 (inpatient respite care), and Q5004 (general inpatient care) billing codes, confirming that the level billed matches the documented clinical status and service intensity for each patient on each day in the billing period.
Medicare requires physician certifications for each benefit period: two 90-day periods followed by unlimited 60-day periods. We track certification status for every patient on census, generate renewal alerts before expiration, and flag any billing period where certification has lapsed or the face-to-face encounter requirement has not been met.
A signed hospice election statement must be on file before any hospice day is billed. When a patient revokes and re-elects, the new election statement and any required waiting periods must be documented before billing resumes. We track election status for every patient and confirm documentation currency before each claim period.
Routine home care days must be supported by clinical visit records from the hospice team: nursing visits, aide services, social work, chaplaincy, and volunteer documentation. We review clinical records against billed days before submission to confirm that the documentation on file supports the claim.
Accounts Receivable Follow-Up
Hospice AR is reviewed weekly. Unpaid claims are pursued before the timely filing limits close. Level-of-care disputes and certification gap denials are escalated with the clinical documentation and CMS coverage policy that supports the original billing.
Hospice agencies lose revenue and face compliance risk due to the same documentation failures every month. Routine home care days are billed for a week where the clinical record shows no nursing or aide visits. Physician certification periods that expired on day 89, and the billing team did not catch it until the MAC sent a payment suspension notice. Patients who revoked and re-elected the hospice benefit, but the new election statement was not signed before billing resumed. Credex Healthcare’s hospice billing process builds the documentation checks for all three into the daily census review, not the denial follow-up.
End-to-end hospice insurance billing from census reconciliation and level-of-care verification through daily rate code assignment and electronic submission to Medicare, Medicaid, and commercial payers for every patient on census for each billing period.
Our hospice billing specialists apply the correct end-of-life care billing codes and level-of-care codes for every patient and every care day, reducing denials due to errors in hospice documentation and certification lapses.
Certification & Election Management
Physician certification renewals and election statement currency are tracked for every patient across each benefit period. Alerts are generated before certifications expire, so no billing gap occurs from a lapsed certification.
Denial management for hospice claims covers level-of-care disputes, certification-period documentation corrections, election-statement gaps, and clinical-visit documentation deficiencies. Each appeal is built around the clinical records and the Medicare hospice benefit policy that reverses the denial.
Provider application management covers Medicare hospice provider number maintenance, Medicaid hospice enrollment, and commercial carrier credentialing, so your agency's billing never stalls at a credential lapse or renewal gap.
Monthly reports cover census by level of care, revenue by care day type and payer, certification period compliance rate, denial trends by reason code, and hospice billing turnaround time, providing hospice administrators with the financial data to manage the program.
Years of Hospice Billing Expertise
Agency Enrollment & Credentialing Success
Claim Compliance Rate Across All Payers
Support Available for All Your Needs
Customized Hospice Revenue Cycle Solutions
Executive Director
Sandra
“We had a MAC medical review that flagged routine home care billing on 22 patients over a three-month period. The issue was that our clinical documentation and billing systems were not reconciled. Days were being billed where the visit records existed in the chart but had not been finalized before the claim went out. Credex built a daily reconciliation step into the billing workflow that checks finalized clinical documentation against the census before any claim is submitted. We have not had a medical review finding since.”
MD
Marcus
“Physician certification tracking was a manual process before Credex, and certifications were lapsing every few months because nobody was monitoring the 90- and 60-day renewal timelines across a census of 180 patients. Each lapse created an uncovered billing period and a compliance risk. Credex automated the certification calendar, generates alerts 15 days before each renewal is due, and tracks the face-to-face encounter requirement separately. Certification lapses went from a monthly occurrence to zero in the first year.”
Revenue Cycle Manager
Janet
“We operate three hospice programs in two states, and the Medicaid billing rules are different in each state. Our previous billing company was applying one state’s rules across all three programs, and we had recurring Medicaid denials in the second state that nobody could explain. Credex separated the billing by state program, applied the correct rules for each, and the Medicaid denial rate in the problem state dropped from 21% to under 5% in two months.”
DO
Amina
“General inpatient care billing requires nursing documentation of acute symptom management that justifies the GIP level, and most billing companies submit GIP claims without verifying that the clinical notes support that acuity. We had GIP claims denied and downgraded to the routine home care rate on audit. Credex reviews GIP documentation before submission and flags any day where the nursing notes do not establish the symptom intensity that justifies inpatient-level care. Our GIP billing holds up on audit now.”
CFO
Adeyemi
“Managing hospice billing across four agencies meant four different election statement workflows, four different certification tracking systems, and no consolidated view of census-to-revenue performance. Credex standardized the billing process across all four agencies, built one reporting dashboard that shows census by level of care and revenue by payer for each site, and the compliance consistency across locations improved immediately. The first quarterly review with the board after Credex took over was the cleanest presentation I have had in years.”
Agency Assessment
We audit your current hospice billing workflow, census reconciliation process, election statement and certification tracking system, level-of-care documentation practices, AR aging by payer, and denial history by reason code. This shows exactly where billing and compliance gaps exist and which need to be addressed first.
Provider Enrollment Verification
We verify your Medicare hospice provider number, state Medicaid hospice enrollment, and commercial carrier credentialing. Any gaps in provider application management are resolved before new claim periods are submitted.
Documentation & Certification Setup
We review your election statement workflow, build a certification-period tracking calendar for every patient on census, and establish a daily reconciliation process to confirm that clinical visit documentation is finalized before claims proceed to submission for any care day.
Clean Claim Submission
Our hospice billing experts review each patient's statement and certification to ensure they remain valid. They also make sure that the level-of-care codes match the patient's documented clinical status, compare visit records to billed days, and send claims electronically to Medicare, Medicaid, and commercial payers for each billing period.
Denial Management & Follow-Up
As a claim moves through the process, it is tracked. Within 48 hours, denials are looked over again. If there are problems with certification, level of care, voting statements, or clinical documents, they will all be corrected and appealed based on the records and the Medicare hospice benefit policy required by the MAC or payer.
Reporting & Ongoing Optimization
The monthly reports show the number of patients by level of care, the amount of money made by type of care day and payer, the rate of certification compliance, the rate of clinical paperwork match, rejection trends by reason code, and the time it takes for hospice to send out bills. Documentation or process problems that keep happening are fixed at the source, not just by making the same complaints again.
Hospice billing is not outpatient billing or home health billing. The per-diem payment structure, the four-level care-day classification, the physician certification period rules, the election statement requirements, and the clinical documentation standards for each care level are all specific to the Medicare hospice benefit and differ from every other billing specialty. A general billing company applies a standard claims workflow to hospice billing and misses the compliance requirements that are built into every care day. Credex Healthcare focuses on hospice medical billing because this specialty requires daily census management and documentation review that general billing workflows cannot deliver.
Our team works on hospice claims. We know how Medicare's four levels of care billing work, how certification period rules apply across benefit periods, how election statement requirements operate after revocation and re-election, and where hospice billing errors most commonly create both revenue loss and compliance exposure.
Your agency works with one dedicated hospice billing specialist who knows your census, payer mix, certification calendar, and recurring billing patterns in your claims. Issues are handled by someone who already understands the operational and documentation context of your program.
Hospice administrators see census by level of care, revenue by care day type and payer, certification compliance rate, clinical documentation match rate, denial trends, and hospice billing turnaround time in monthly reports that reflect the agency’s actual financial and compliance position.
Patient election statements, clinical records, and hospice documentation handled throughout the billing process are protected under full HIPAA compliance protocols. Documented security standards and strict access controls are maintained across every system used to process your agency's claims.
Hospice agencies lose revenue and face compliance exposure due to recurring billing gaps. Routine home care days are billed without finalized clinical visit documentation in the record. Physician certifications that lapsed unnoticed created uncovered billing periods. Election statements were not updated after a patient revoked and re-elected the benefit. These are not billing mistakes that happen once. They are workflow problems that repeat until someone audits them and fixes the process.
Credex Healthcare starts with a free review of your current hospice billing: census reconciliation accuracy, certification period compliance rate, election statement currency, clinical documentation match rate, and AR aging by payer. No commitment required to get that review. We identify specific revenue gaps and compliance risks and show you what fixing the underlying workflow looks like before you decide.
Hospice billing is the claims process for Medicare-certified hospice programs and other hospice providers submitting daily rate claims to Medicare, Medicaid, and commercial payers for patients who have elected the hospice benefit. Unlike standard fee-for-service billing, hospice billing is per-diem based. Medicare pays a daily rate for each calendar day the patient is on the hospice census, at one of four care levels, rather than for individual services.
Yes. Medicare Part A covers hospice care when a patient elects the hospice benefit, and two physicians certify a terminal prognosis of six months or less if the disease runs its normal course. Coverage includes nursing care, aide services, social work, counseling, medications related to the terminal diagnosis, and medical equipment. Credex Healthcare verifies hospice eligibility and payer-specific requirements before billing begins.
Medicare processes clean electronic hospice claims in 14 to 30 days when certification and election documentation are current, and level-of-care codes match the clinical record. Commercial payers typically pay within 30 days when documentation meets the payer’s hospice coverage criteria. Medicaid timelines vary by state, generally 30 to 60 days. Credex Healthcare’s daily documentation review and certification tracking address all three before claims are submitted, keeping most hospice claims within the standard hospice billing turnaround time.
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