0 days
To file the NOE and Medi-Cal attestation
Hospice billing & RCM · California
Hospice Billing Services That Protect Your Revenue and Compliance
Expert hospice billing and revenue cycle support for hospice agencies: NOEs, levels of care, cap monitoring and ADRs handled end to end, so you get paid faster while staying compliant with Medicare hospice rules.
- NOE, NOTR and Medi-Cal attestation tracking
- Medicare, Medi-Cal and managed care hospice claims
- Monthly aggregate and inpatient cap projections
- ADR, prepayment review and audit support
HIPAA and CMIA-aligned workflowsPacific business-hours supportSan Diego, CA
$0,0.00
FY 2027 aggregate cap per beneficiary
0
Levels of care billed on the UB-04
0 pts
Annual update lost for missed HQRP reporting
Figures from current CMS and DHCS hospice rules (October 2026).
Hospice billing challenges
Where Hospice Revenue Slips Away
Hospice billing is per-diem, election-driven and heavily audited. One missed date can deny an entire benefit period.
01
Missed or late NOE filing
Medicare doesn't pay for days before a late NOE is accepted, and Medi-Cal denies claims without the DHCS "900" attestation indicator.
02
Aggregate and inpatient cap overpayments
Long lengths of stay and GIP days above the 20% inpatient limit surface only when the MAC's demand letter arrives.
03
Benefit periods and face-to-face encounters
A late recertification or missing face-to-face before the third benefit period makes those days non-billable.
04
Billing the four levels of care
RHC, CHC, GIP and IRC each need the right revenue code and documentation; CHC and GIP days are denied when crisis records fall short.
05
Missed Service Intensity Add-on (SIA)
RN and social worker visits in the last seven days of life go unpaid when SIA isn't captured on the claim.
06
HQRP compliance penalties
Missing HOPE and CAHPS Hospice submissions costs 4 percentage points of the annual payment update.
07
Denials, ADRs and audit exposure
California hospices face PPEO and Expanded Prepayment Review, so every claim needs a complete record, fast.
Not sure which of these is costing you? Request a hospice revenue leak review.
Care at the bedside
Billing That Lets Your Team Stay With Patients
Every election, certification and visit becomes part of the claim. We keep those records aligned so care isn't interrupted by billing.
One accountable team
Our Hospice Billing Services
From referral to cap reconciliation, each service is built around a specific Medicare or Medi-Cal hospice rule.
Eligibility & Benefit Verification
Medicare election history, Medi-Cal EVS, Share of Cost, plan assignment and commercial hospice benefits checked before admission.
NOE / NOTR Filing and Tracking
NOEs, NOTRs and DHCS attestations filed inside the five-calendar-day window, with every revocation and transfer tracked.
Hospice Claims Submission (UB-04 / 837I)
Type of bill 081X/082X, Q-codes, G-codes and occurrence codes scrubbed against Medicare and Medi-Cal edits.
Level of Care & Revenue Code Accuracy
RHC 0651, CHC 0652, IRC 0655, GIP 0656, physician services 0657 and room and board 0658 billed correctly.
Cap Management & Monitoring
Monthly aggregate and inpatient cap projections, plus the year-end self-determined cap report.
Denial Management & Appeals
Every denial worked by root cause, with appeals through every Medicare level up to the ALJ.
ADR and Audit Support
ADR packets and responses for prepayment review, TPE, UPIC, RAC and Medi-Cal plan audits.
AR Follow-up & Collections
Unpaid claims chased by payer, enforcing California's 30-calendar-day prompt pay rule with managed care plans.
Payment Posting & Reconciliation
ERAs posted, underpayments flagged and room and board reconciled with each facility.
Compliance & Quality Reporting Support
CTI, election statement, addendum and HQRP deadlines tracked so claims and quality data stay compliant.
Monthly Financial Reporting
Census, days by level of care, live discharge rate, cap position and A/R aging every month.
Levels of care
The Four Hospice Levels of Care We Bill
Each level has its own revenue code, rate and documentation requirements.
| Level of care | Revenue code | When it applies |
|---|---|---|
| Routine Home Care (RHC) | 0651 | Standard care at home or in a facility; higher rate for days 1-60, lower for days 61+ |
| Continuous Home Care (CHC) | 0652 | Crisis care at home, billed by the hour, at least 8 hours in a 24-hour day, mostly nursing |
| Inpatient Respite Care (IRC) | 0655 | Short caregiver relief stays, up to 5 consecutive days |
| General Inpatient Care (GIP) | 0656 | Symptom management that cannot be done at home |
Step by step
Our Hospice Billing Process
A predictable monthly workflow from intake to reporting.
- 0
Patient Intake & Verification
Election history, Medi-Cal eligibility, Share of Cost and plan assignment verified before admission.
- 0
NOE Filing
NOE filed with NGS and the DHCS attestation or plan election notice sent inside five calendar days.
- 0
Documentation & Coding Review
CTI, recertifications, face-to-face encounters and level-of-care records checked against each claim.
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Claim Submission
Monthly claims built from your EMR with Q-codes, G-codes, SIA and room and board, then submitted with proof of timely filing.
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Payment Posting
ERAs posted and underpayments identified; unpaid managed care claims chased from day 31.
- 0
Denial Management
Every denial worked and every ADR answered before its deadline with a complete record.
- 0
Reporting & Analysis
Monthly census, level-of-care mix, live discharge rate, cap projection and A/R aging.
California compliance
Hospice Rules Your Billing Must Survive in 2026
California hospices face the closest federal and state review in the country.
| Rule or program | What it means for billing | Since |
|---|---|---|
| CMS Provisional Period of Enhanced Oversight (PPEO) | New, reactivating or newly acquired California hospices face medical review, including prepayment review, for 30 days to 1 year | July 13, 2023 |
| CMS Expanded Prepayment Review (EPR) | Existing California hospices can have claims reviewed before payment | September 17, 2024 |
| CMS nationwide hospice enrollment moratorium | Six-month freeze on new Medicare hospice enrollments, new practice locations and some ownership changes | May 13, 2026 |
| CDPH hospice licensing regulations (22 CCR §§74800-74908) | First comprehensive state licensing, staffing and governance rules; unannounced inspections; the SB 664 licensing moratorium continues | June 22, 2026 |
| DHCS Medi-Cal Hospice Program Attestation | Online attestation within 5 calendar days of election; claims denied without the "900" indicator | 2025-2026 |
| FY 2027 Hospice Final Rule (CMS-1851-F) | 2.3% rate update; $36,174.75 cap; election statement addendum now required for every patient; SSVI spending scores published | October 1, 2026 |
| HOPE assessment (replaced HIS) | Quality data feeds the HQRP; missing it costs 4 percentage points of the annual update | October 1, 2025 |
Rule references reflect October 2026 and can change. Confirm current CMS, CDPH and DHCS notices before billing.
Audit-ready documentation
From the Plan of Care to the Paid Claim
Clinical and billing teams review the same records, so every claim is ready for prepayment review before it leaves.
Why choose us
Why Hospices Choose California Billing Services
Hospice-specific billing expertise
NOEs, benefit periods, levels of care, SIA and cap rules handled by a team that works these claims every month.
Compliance-first approach
We bill only what your documentation supports and tell you in writing when a claim shouldn't be billed.
Faster, cleaner reimbursement
Claims are checked against the election record and clinical documentation before they leave, reducing rework.
California payer knowledge
Plan-by-plan workflows for Medi-Cal managed care plans such as L.A. Care, IEHP and CalOptima Health.
Transparent reporting
Census, cap position, denials and A/R reported monthly, so there are no year-end surprises.
HIPAA-compliant processes
HIPAA and California CMIA-aligned data handling with role-based access to your hospice EMR.
Statewide coverage
Hospice Billing Across California
Related specialties
FAQ
Hospice Billing FAQs
The Medicare NOE must be filed and accepted within five calendar days of the election date. Medicare doesn't pay for days before a late NOE is accepted. Medi-Cal members also need a DHCS Hospice Program Attestation within five calendar days.
Can't find what you're looking for? Contact our billing specialists
Your next step
Ready to Simplify Your Hospice Billing?
Send us recent claims and remittances. We'll review late or missing NOEs and Medi-Cal attestations, denials and unpaid claims by payer, your projected FY 2027 cap position, unbilled room and board and missed SIA payments, and documentation gaps a prepayment reviewer would flag.