Hospice billing hinges on the 5-day Notice of Election, the correct level-of-care revenue code (RHC, CHC, GIP, Respite), and face-to-face recertification windows. A late NOE can deny an entire election period. MedFactor delivers hospice-specific RCM that protects every election, every level, and every patient family you serve.
From home hospice and general inpatient care to pediatric palliative and bereavement, we tailor billing to the level-of-care and election rules of every program.
Routine Home Care (651) per-diem billing, service-intensity add-on capture in the last 7 days of life, and NOE timeliness for home-based elections.
GIP (656) level-of-care documentation for unmanageable symptom crises, inpatient facility billing, and the 20% inpatient cap monitoring.
Pediatric hospice and concurrent-care billing, age-appropriate level-of-care selection, and family-centered documentation support.
Outpatient palliative E/M, advance care planning (99497/99498), and telehealth consults with proper modifier and place-of-service capture.
Bereavement services tracking, family contact documentation, and the compliance boundaries of non-billable bereavement under the hospice per diem.
Hospice in SNF/ALF settings, facility room-and-board coordination, and RHC per-diem accuracy for long-term-care residents.
Hospice billing is governed by election periods, the correct level-of-care revenue code for each day, and the 5-day Notice of Election deadline. A late NOE is the single largest hospice revenue loss — it can deny payment for an entire election period.
A hospice election runs an initial 90-day period, a subsequent 90-day period, then unlimited 60-day recertification periods — each requiring physician recertification and a face-to-face encounter.
Hospice billing is governed by election-period deadlines, level-of-care documentation, and modifier rules that general billing companies cannot navigate effectively.
Notice of Election filed past the 5-day window, putting payment for the entire election period at risk.
General Inpatient (656) billed without documentation of an unmanageable symptom crisis that requires inpatient care.
Face-to-face recertification encounter not completed inside the required window before each recertification period.
Non-terminal-related services for a hospice patient billed without the GW modifier, triggering denials as bundled into the hospice per diem.
Curative and hospice services billed together without proper concurrent-care or modifier separation for eligible patients.
Advance care planning (99497/99498) billed without the time-based documentation or without the qualifying visit to support it.
Quick reference for the most frequently used codes in hospice and palliative care billing and coding.
| Code | Description | Common Use |
|---|---|---|
| 99497 | Advance care planning, first 30 min | Goals-of-care conversation |
| 99498 | Advance care planning, each addl 30 min | Extended ACP session |
| G0182 | Physician care plan oversight, hospice | ≥30 min/month, attending physician |
| 99202–99215 | Office / outpatient E/M | Palliative consult visits |
| 99307–99310 | Nursing facility E/M | SNF / NF palliative visits |
| 651 | Revenue code — Routine Home Care (RHC) | Home / residence per-diem |
| 652 | Revenue code — Continuous Home Care (CHC) | Crisis day, ≥8h nursing |
| 655 | Revenue code — Inpatient Respite Care | Caregiver relief, ≤5 days |
| 656 | Revenue code — General Inpatient (GIP) | Unmanageable symptom crisis |
| Code | Description | Clinical Context |
|---|---|---|
| Z51.5 | Encounter for palliative care | Primary palliative encounter |
| C78.x | Secondary malignant neoplasm | Terminal / metastatic cancer |
| C34.x | Malignant neoplasm of lung / bronchus | Common terminal diagnosis |
| J96.x | Respiratory failure | End-stage respiratory disease |
| I50.x | Heart failure | End-stage cardiac disease |
| N18.6 | End-stage renal disease (ESRD) | Terminal renal disease |
| G20 | Parkinson’s disease | End-stage neurodegenerative |
| C50.x | Malignant neoplasm of breast | Terminal malignancy |
| C61 | Malignant neoplasm of prostate | Terminal malignancy |
| Modifier | Description | Hospice Application |
|---|---|---|
| GW | Service not related to terminal condition | Non-terminal-related care for a hospice patient |
| GV | Attending physician not hospice-employed | Attending physician services under hospice election |
| GZ | Not reasonable / necessary, no ABN | Service expected to be denied |
| GA | ABN on file | Service may not be covered; liability shifted |
| 25 | Separate E/M same day | E/M with same-day procedure / ACP |
| 95 | Synchronous telehealth (audio + video) | Palliative telehealth consults |
| 32 | Mandated service | Service required by law / order |
| 52 | Reduced service | Procedure partially reduced / not completed |
Comprehensive revenue cycle management designed specifically for hospice and palliative care programs.
Specialty coders handle NOE timeliness, level-of-care revenue codes (651/652/655/656), and election-period compliance with accuracy.
Late-NOE appeals, GIP level-of-care defense, and F2F recertification corrections with documentation that supports each claim.
5-day Notice of Election filing workflows and tracking that protect payment for the entire election period from day one.
RHC, CHC, GIP, and Respite documentation aligned to the criteria each level requires, with the 20% inpatient cap monitored.
Prioritized follow-up on aged hospice claims, election-period corrections, and payer escalation to maximize recovery.
Real-time dashboards tracking NOE timeliness, level-of-care mix, GIP days, and the inpatient cap against your program.
Understanding the most common denial reasons is the first step to preventing them on hospice election and level-of-care claims.
NOE filed more than 5 days after election, putting payment for the entire election period at risk.
5-day NOE filing workflow with deadline tracking from the first day of election.
General Inpatient (656) billed without documentation of an inpatient symptom crisis that cannot be managed elsewhere.
Unmanageable-symptom documentation templates that justify each GIP day.
Required face-to-face encounter not completed inside the recertification window before the next period begins.
F2F scheduling windows tracked per patient and triggered ahead of each recertification.
Non-terminal-related services for a hospice patient billed without GW, denied as bundled into the per diem.
GW appended automatically for unrelated care, with GV for the attending physician where applicable.
Identifying and plugging these common revenue leakage points can significantly improve your program’s financial and compliance posture.
NOE filed past 5 days, risking the entire election period’s payment.
GIP days billed without unmanageable-symptom support, denied on audit.
Unrelated services for hospice patients denied as bundled without GW.
Advance care planning time not captured and billed with supporting documentation.
See how hospice-specific revenue cycle management transforms your program’s compliance and financial performance.
A structured onboarding process designed to deliver measurable improvements within the first 90 days.
Review of hospice billing operations, NOE timeliness, level-of-care mix, and revenue cycle baseline.
Hospice EMR integration, dedicated billing team, and payer enrollment verification.
Full billing with real-time NOE filing, level-of-care verification, and denial-prevention protocols.
Performance review against baseline, workflow optimization, and documented revenue improvement.
How our hospice-specific approach compares to in-house billing and general medical billing companies.
| Capability | In-House Team | General Billing Co. | MedFactor Hospice |
|---|---|---|---|
| 5-day NOE timeliness tracking | Inconsistent | × | ✓ |
| Level-of-care revenue code accuracy (651/652/655/656) | × | × | ✓ |
| GIP unmanageable-symptom documentation | Inconsistent | × | ✓ |
| Face-to-face recertification scheduling | Manual | Partial | ✓ |
| GW / GV modifier accuracy | Inconsistent | Partial | ✓ |
| Advance care planning (99497/99498) capture | Manual | Partial | ✓ |
| 20% inpatient cap monitoring | Manual | × | ✓ |
| NOE timeliness reporting | × | × | ✓ |
| Dedicated hospice billing team | × | × | ✓ |
Our team combines deep hospice and palliative billing expertise with the technology and processes to protect every election period, every level of care, and every family’s experience.
Discover exactly where your hospice program is losing revenue. Our no-obligation audit analyzes your NOE timeliness, level-of-care capture, and modifier compliance.
Real results from hospice and palliative programs that partnered with MedFactor for specialty revenue cycle management.
A home hospice was filing Notices of Election past the 5-day window and losing entire election periods to denial. MedFactor implemented a 5-day NOE workflow with deadline tracking, recovering substantial revenue across the year.
An inpatient hospice was under-capturing General Inpatient (656) days because symptom-crisis documentation did not meet the unmanageable-symptom criteria. MedFactor implemented documentation templates that supported each GIP day.
A palliative consult service was not capturing advance care planning time (99497/99498) during visits. MedFactor implemented time-based documentation that grew billable palliative consult volume without adding staff.
No matter where your hospice program operates, our team understands the Medicare hospice benefit and the state Medicaid landscape in your region.
Deep knowledge of Medicare hospice benefit rules, per-diem rates, and the service-intensity add-on.
5-day Notice of Election filing policy applied correctly across all Medicare Administrative Contractors.
General Inpatient coverage criteria and the 20% inpatient cap applied consistently across regions.
State Medicaid hospice rates and coverage rules applied correctly in every state your program serves.
Common questions from hospice and palliative programs considering MedFactor’s specialty RCM services.
The Notice of Election (NOE) must be filed within 5 calendar days of the hospice election date (counting the election date as day 1). If the NOE is filed late, payment for the entire election period is at risk — Medicare can deny the period from the election date forward, and a late NOE is the single largest source of hospice revenue loss. We file NOEs inside the 5-day window with deadline tracking from the first day of election so every election period is protected.
Medicare pays hospice a per-diem based on four levels of care, each with its own revenue code: Routine Home Care (651) for care at home or in a facility used as a residence; Continuous Home Care (652) for a crisis day with at least 8 hours of predominantly nursing care in 24 hours; General Inpatient Care (656) for an inpatient stay to manage unmanageable symptoms; and Inpatient Respite Care (655) for short-term caregiver relief (max 5 consecutive days). The level is determined by the acuity of care required, not the setting alone. We match each day to the correct revenue code.
General Inpatient (GIP) care is justified when pain or acute/chronic symptom management cannot be feasibly managed in another setting and requires inpatient care. The documentation must show that the patient’s symptoms could not be managed at home — for example, uncontrolled pain, severe dyspnea, or intractable nausea requiring round-the-clock nursing and physician intervention. GIP is not simply hospital-level care; it is a hospice level of care tied to symptom crisis. We use unmanageable-symptom documentation templates that justify each GIP day and monitor the 20% inpatient cap.
Advance care planning is billed with 99497 for the first 30 minutes of a face-to-face conversation between a physician or qualified provider and the patient (or surrogate) about goals of care and future treatment, and 99498 for each additional 30 minutes. The time must be documented and the visit must be medically appropriate. 99497/99498 can be billed separately from a hospice per diem for the attending physician’s services. We capture ACP time with supporting documentation so palliative consult volume is billed without leaving revenue on the table.
The GW modifier (“service not related to the terminal condition”) is appended when a hospice patient receives a service that is not related to their hospice terminal prognosis. Because the hospice per diem covers care related to the terminal condition, unrelated services must carry GW or they are denied as bundled into the per diem. The GV modifier is used when the attending physician is not employed by or under arrangement with the hospice. We apply GW for unrelated care and GV for the attending physician so non-terminal services are paid rather than denied.
We integrate with all major hospice and palliative EMR and clinical platforms including Epic, Cerner, Athenahealth, and dedicated hospice systems. Our team works with your level-of-care documentation, election records, and face-to-face encounter data so the NOE, level-of-care revenue code, and modifier detail flow cleanly to correct claim submission — protecting every election period and every level of care your program delivers.
MedFactor applies the same code-level precision across the full practice spectrum. See how we bill these related specialties.
CPT®, ICD-10, HCPCS, and modifier codes referenced on this page reflect the current code sets and are subject to annual updates — always verify against the current-year fee schedule before submission. KPIs and case-study figures shown are representative benchmarks, not guarantees of individual program results.
Your hospice program deserves a billing partner who knows the 5-day NOE, every level-of-care revenue code, and the documentation that holds up under audit. Let MedFactor show you what specialty hospice RCM can do.