Generic hospice billing companies often overlook the unique “Two-Tier” Routine Home Care (RHC) payment system and the catastrophic financial impact of out-of-sequence claim rejections with revenue cycle optimization designed for this level of complexity.
To prevent these costly errors, our hospice billing experts provide targeted hospice certified medical coding, handling the intricate compliance and claims work that generic agencies frequently miss.
Medicare requires the Notice of Election (NOE) to be filed and accepted within 5 calendar days of the admission date. Revix MD guarantees submission within 24 hours of the election. We eliminate the “provider-liable” penalty by utilizing real-time DDE (Direct Data Entry) verification.
Effective October 1, 2025, the HOPE tool replaced the HIS. We ensure your clinical update visits (HUVs) are perfectly synchronized with your billing claims. This protects your 4% HQRP payment adjustment, which is at risk if HOPE data is missing or misaligned according to the Hospice Quality Reporting Program (HQRP) requirements.
A single rejected claim in a sequence can halt your entire revenue stream, and structured reduce claim denials reduce the risk of this happening again. Our proprietary pre-scrubbing engine identifies MA40 remark code risks (where admission and “from” dates mismatch after April 2026), preventing technical rejections before they reach the MAC.
We provide complete billing coverage for every phase of hospice and palliative care. Our hospice billing specialists manage hospice RCM, palliative care billing, and end-of-life care billing from admission through discharge.
We manage the complex “Two-Tier” RHC payment system, ensuring your claims accurately transition from the “High” rate (Days 1–60) to the “Low” rate (Day 61+) without technical denials.
Service Intensity Add-on (SIA): We capture every billable RN and Social Work visit provided during the last 7 days of life. Our system monitors the patient’s level of care (RHC) and clinical status to ensure these high-value add-ons are included on the final claim.
General Inpatient (GIP) and Continuous Home Care (CHC) are the primary targets for hospice ADR audits. We audit your clinical documentation to ensure it supports the crisis-level intensity required for the $69.76/hour CHC rate.
2026 CHC Rate: $69.76/hour. We track hourly documentation in real-time to ensure you meet the 8-hour minimum.
We file the Notice of Termination/Revocation (NOTR) within 2 days of discharge to release the patient’s record for other providers. Late filings create claim overlaps that trigger denials for both your agency and the receiving provider. Our team tracks every live discharge in real time, coordinates with downstream providers, and confirms the revocation posts correctly in the MAC system so no billing conflicts follow you after the patient leaves your care.
Under the ACA, children can receive curative treatment alongside hospice. We code curative and palliative claims separately to prevent “duplicate billing” rejections. For patients not on the hospice benefit yet, we bill palliative E/M visits (99202–99215) with the G2211 complexity add-on. NP and physician consultations get billed with the correct GV and GW modifiers to separate terminal-related from unrelated care. We handle fee schedule claims, facility billing, and multi-payer coordination for agencies expanding into palliative programs.
In 2026, Targeted Probe and Educate (TPE) audits focus on the “6-month prognosis” narrative. Revix MD provides a hospice ADR audit defense that starts at the point of admission.
CMS now allows Face-to-Face (F2F) attestations to be part of the clinical note. We audit these notes to ensure they contain the specific signature, date, and narrative requirements to survive high-stakes reviews.
The aggregate cap for the 2026 cap year is $35,361.44. We provide monthly “Cap Room” reports, alerting your CFO to potential overpayment penalties well before the October reconciliation deadline.
For agencies trying to figure out which hospice billing company to trust with their revenue, our compliance-first approach means your billing is always survey-ready, not just fast.
Switching your hospice per diem billing requires a “zero-gap” transition to protect your active census.
See why hospice leaders across the U.S. trust Revix MD as their hospice billing consulting partner for compliance, revenue recovery, and audit defense.
Revix MD eliminated our provider-liable days. Their mastery of the 5-day NOE rule saved our agency thousands. We no longer worry about missed deadlines or technical denials.
Dr. John Codwell — Codwell Family Foot Center
Their team transformed our GIP billing process. We’ve seen a 98.2% clean-claim rate and total protection during ADR audits. Our cash flow is finally stable.
Jouvonna Gray, NP — Get Well HealthCare Services
Transitioning to palliative care was seamless with Revix MD. They maximized our physician fee schedule reimbursements, allowing us to expand services while remaining compliant.
Amer Khan — Omali Diagnostic, LLC
Let Revix MD handle the technical complexities of hospice and palliative care billing while you focus on what matters most.
Yes. Both RN and Social Work visits provided during the last 7 days of life (at the RHC level) are billable under the Service Intensity Add-on (SIA), provided they are for direct patient care rather than administrative tasks.
We file the NOTR within 48 hours of discharge and scrub the final claim for the correct status code. This prevents the “open election” errors that lead to Medicare recoupment and patient transfer conflicts.
Medicare hospice billing is rules-based. CMS sets fixed per diem rates for four levels of care (RHC, CHC, IRC, GIP), adjusted by wage index. Claims go through your MAC on a UB-04 in sequential order. No negotiation, no contract variation.
Commercial payers are contract-by-contract. Some mirror Medicare rates, others negotiate custom per diems or bundled case rates. Filing deadlines, authorization rules, and documentation thresholds vary by carrier. Medicaid follows the Medicare structure but with state-level wage index adjustments.
Revix MD runs each payer type as a separate billing workflow.
We manage the state-specific election forms and per diem room-and-board rates. Since Medicaid often acts as the secondary payer for nursing home residents, we ensure the “95% of the room and board” rate is captured correctly.
Hospice billing runs on a per diem (per-day) payment model, not a per-visit or per-procedure model. Medicare pays the hospice a flat daily rate based on the patient’s level of care, and that single payment covers every service tied to the terminal diagnosis, nursing, medications, DME, social work, chaplaincy, and aide visits. The hospice absorbs the cost regardless of how many visits happen in a given day.
