The Hospice Billing Playbook: A Step-by-Step Guide to Success

Hospice billing is a complex and intricate process, but it's essential for providers to get paid for the valuable services they deliver to patients and their families.

To help hospice agencies optimize their billing procedures, this blog post presents essential tips for efficient and accurate hospice billing. SimiTree's Lynn Labarta, VP of Post Acute Revenue Cycle Management, shares expert tips with clear actionable items you can take to achieve hospice billing success, including staying updated with Medicare regulations, verifying insurance eligibility, accurate diagnosis coding, timely submission of claims, and thorough documentation.


1. Verify Insurance Eligibility

Before initiating hospice services, verify the patient's insurance eligibility and benefits coverage. It is crucial to confirm whether the patient has an active hospice benefit and if any prior authorizations or pre-certifications are required. By proactively confirming insurance information, you can avoid claim denials due to coverage issues or eligibility discrepancies.

Avoid the common pitfalls of home health insurance eligibility with this blog from SimiTree’s Lynn Labarta, VP of Post Acute Revenue Cycle Management. Download this free cheat sheet that drills down into the details that you need to know about insurance eligibility.

2. Accurate Diagnosis Coding

Accurate diagnosis coding is critical for hospice billing. Ensure that the primary and secondary diagnosis codes reflect the patient's terminal condition and any related comorbidities accurately.

Regularly review the International Classification of Diseases (ICD) coding guidelines and updates to stay current with coding practices. Proper coding supports medical necessity and improves the chances of claims acceptance!

3. Timely Submission of Claims

Timely claim submission is essential for maintaining cash flow and reducing reimbursement delays. To ensure that claims are submitted within the designated timeframe, hospice providers should establish a robust internal process and monitor submission deadlines. They should also implement a system to track and follow up on any pending or rejected claims.

By submitting claims promptly, hospice providers can increase the chances of receiving prompt reimbursement from Medicare and other payers.

4. Stay Updated with Medicare Regulations

Medicare is the primary payer for hospice services in the United States, and its regulations continually evolve. It is crucial for hospice providers to stay updated with the latest Medicare guidelines, coding changes, and documentation requirements. Regularly reviewing official resources such as the Medicare Benefit Policy Manual and Medicare Learning Network materials will help ensure compliance and minimize claim denials.

Learn more about Medicare for home health agencies with SimiTree experts Rob Simione, CPA, Principal, SVP Consulting, and Jonathan Dickinson, Senior Manager, Financial Consulting, who hosted a webinar about how home care agencies can win in the Medicare Advantage market. In a rush? Just read the top FAQs on Medicare contracting from webinar attendees.

5. Thorough Documentation

Thorough and comprehensive documentation is the cornerstone of successful hospice billing. Make sure that all patient records are complete, including the hospice plan of care, physician certifications, and detailed progress notes.

Documenting the patient's terminal prognosis, symptom management, and supportive services provided by the interdisciplinary team is essential for establishing medical necessity and justifying billed services.

6. Regular Audits and Quality Checks

Regular internal audits and quality checks are essential for ensuring billing accuracy and compliance. By conducting periodic reviews of claims, documentation, and coding practices, hospice providers can identify and rectify billing errors, reduce claim rejections, and identify areas for improvement. A robust quality assurance program can help hospice providers achieve these goals by:

· Establishing clear standards and procedures for billing.

· Providing training and education on billing regulations and best practices.

· Monitoring billing performance and identifying areas for improvement.

· Taking corrective action to address billing errors.


How SimiTree Can Help

Efficient and accurate billing practices are vital for the financial sustainability of hospice organizations.  

At SimiTree, we understand the complexities of hospice billing and collections. Our team of Revenue Cycle Management (RCM) experts specialize in the hospice industry and have the training necessary to make your billing processes efficient and profitable. By partnering with us, you can expect a seamless extension of your office, with skilled professionals who ensure regulatory compliance and expedite the claims process. What to expect:

  • We provide clear and concise reports that offer transparency into operational issues that may hinder timely billing and payment.
  • Our proprietary collections tool identifies any revenue obstacles upstream, allowing you to take corrective action promptly and improve cash flow.

To explore how partnering with SimiTree empowers your agency with specialized billing support, fill out our contact us form below or give us a call today at 1.800.949.0388.

Contact Us

Let's work together to improve the health of your organization. At SimiTree, we balance financial expertise and clinical excellence to help our clients grow. How can we help you? Call us at 866.839.5471 or complete the form below.