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HOSPICE BILLING SERVICES

ASP-RCM Hospice billing services.

Hospice billing built around Medicare cap management, level-of-care transitions, face-to-face recertification, NOE timely filing, and GIP documentation.ontinuous Home Care complexities. Senior leadership, three-pod model.

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Where the depth is

The Hospice specialty stack.

For Hospice CFOs, owners, and clinical-administrative leaders. Every item below runs in production today across the active client portfolio.

01

Cap management discipline

Monthly cap projection per beneficiary. No end-of-year surprises.

02

Level-of-care transitions

Clean Routine Home Care, Respite, Continuous Home Care, GIP transitions

03

Face-to-face compliance

FTF documentation captured pre-bill, never post-denial

04

Pre-bill audit

DRG and HCPCS validation before claim submission

05

Recertification tracking

Benefit period recertification deadlines tracked per patient

06

Survey + audit defense

Documentation packets ready for MAC, ZPIC, and state survey

FY 2026 cap and revenue map

Where a hospice runs out of cap, drawn to scale.

There is no honest dashboard screenshot to show you here, so we built the exhibit instead. Everything plotted below is arithmetic on published CMS FY 2026 rates, not sample data and not a client.

Medicare hospice FY 2026 cap and level of care revenue map CUMULATIVE ROUTINE HOME CARE PAYMENT FOR ONE BENEFICIARY, AGAINST THE FY 2026 AGGREGATE CAP $40k$30k$20k$10k$0 day 0day 60day 120day 180200 FY 2026 aggregate cap amount per beneficiary: $35,361.44 Cap crossed onabout day 179 Day 60: rate steps downfrom $230.83 to $181.94 Arithmetic: 60 days at $230.83 = $13,849.80. The remaining $21,511.64 of cap headroom buys 118 more days at $181.94. FY 2026 MEDICARE PAYMENT RATE BY LEVEL OF CARE, PER DAY Routine home care, days 1-60 Routine home care, days 61+ Inpatient respite care General inpatient care Continuous home care, 24 hours $230.83$181.94$532.48 $1,199.86$1,674.29 · $69.76 per hour Rates and cap amount are the final FY 2026 figures, effective October 1, 2025. Wage index adjustment applies to the labour portion, so your realised rate differs by locality.

Source: CMS, Medicare Program; FY 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements, final rule, 90 FR 37404, published August 5, 2025, effective October 1, 2025. Cap crossover day is ASP-RCM arithmetic on those published rates, shown above so you can check it.

The numbers that govern your cap year

Six hospice figures your CFO should be able to recite.

Every figure below is a current federal rule or a stated arithmetic derivation from one. Nothing here is an estimate.

$35,361.44
FY 2026 aggregate cap

Per beneficiary cap amount for the FY 2026 cap year, up from $34,465.34 in FY 2025.

CMS FY 2026 Hospice final rule, 90 FR 37404
2.6%
FY 2026 payment update

A 3.3% market basket increase less a 0.7 percentage point productivity adjustment. It moved both the rates and the cap.

CMS FY 2026 Hospice final rule, 90 FR 37404
5 days
NOE timely filing window

The Notice of Election must be filed within 5 calendar days of the election effective date. File late and Medicare covers nothing from the election date to the filing date. Those days are provider liability and cannot be billed to the beneficiary.

42 CFR 418.24(e) and (f)
Day 179
RHC-only cap crossover

At published FY 2026 rates, cumulative routine home care payment for a single beneficiary passes the cap amount at roughly day 179. Long-stay mix is the whole cap conversation.

ASP-RCM arithmetic on CMS FY 2026 published rates
$1,199.86
GIP per diem, FY 2026

General inpatient care pays roughly five times routine home care. It is also the level of care auditors look at first, so eligibility documentation has to be airtight.

CMS FY 2026 Hospice final rule, 90 FR 37404
180 days
Face-to-face trigger

A hospice physician or nurse practitioner must have a face-to-face encounter prior to the 180-day recertification and prior to every recertification after it. FY 2026 tightened the attestation: it must carry the signature and the date of signature of the practitioner who conducted the encounter.

SSA 1814(a)(7)(D)(i); 42 CFR 418.22(b)(4) as revised by the FY 2026 final rule

Revenue leakage taxonomy

Five ways hospice revenue gets taken back.

Hospice revenue rarely leaks at the claim. It leaks at the election, at the recertification, at the level-of-care decision and at the cap-year reconciliation, which means it leaks quietly and lands as a repayment demand months later.

Leakage driverHow it actually happensThe control we installWhen it bites
Cap liabilityAggregate cap overageLong-stay mix quietly pushes aggregate payments past the number of cap allowances the census earns. Nobody sees it until the cap year is reconciled and the MAC issues a demand for the overage.Per beneficiary cap projection refreshed monthly, rolled to an agency level cap position with headroom stated in dollars and in days, so admissions and cap sit in the same conversation.Cap year end
NOE timely filing5 calendar daysThe Notice of Election misses the 5 calendar day window. Medicare covers nothing from the election effective date to the filing date, the days become provider liability, and they cannot be billed to the beneficiary.NOE filed as an admission-day task with a hard clock, escalation at day 2, and an exception file built at the time of the event rather than reconstructed later.Immediately
Face-to-face recertification180-day mark onwardThe encounter happens but the attestation is incomplete. Under the FY 2026 rule the attestation must carry the signature and the date of signature of the practitioner who conducted the encounter, or a signed and dated clinical note that shows the encounter occurred.Face-to-face captured pre-bill against the FY 2026 attestation elements, never reconstructed after a denial, with the recertification calendar tracked per patient per benefit period.Recert cycle
Level-of-care documentationRHC, CHC, IRC, GIPThe level of care billed is not the level of care the clinical record supports. Continuous home care in particular requires a period of crisis and predominantly nursing hours, and the hourly billing has to reconcile to the visit record.Level-of-care transitions validated against the clinical record before the monthly claim, with continuous home care hours reconciled to nursing documentation line by line.Pre-bill
GIP eligibilityThe audit magnetGeneral inpatient care pays roughly five times routine home care, which is exactly why it draws MAC, UPIC and SMRC review. Symptoms that could have been managed at home do not support GIP, and the recoupment is retrospective.GIP eligibility screened at the point of transition against symptom acuity, with the documentation packet assembled contemporaneously so an audit response is retrieval rather than reconstruction.Post-payment

Regulatory citations for this table: cap amount and payment rates from the CMS FY 2026 Hospice final rule, 90 FR 37404; Notice of Election timely filing from 42 CFR 418.24(e) and (f); face-to-face encounter and attestation from SSA 1814(a)(7)(D)(i) and 42 CFR 418.22(b)(4).

Workflow

Election to cash, with the clocks that actually run.

Hospice billing is a sequence of deadlines, not a sequence of claims. Three of the five stages below have a clock attached, and missing any one of them converts covered care into provider liability.

Hospice election to cash workflow 0102030405 Election statementsigned NOE filedwithin 5 calendar days Certification andface-to-face attestation Level of care codeddaily against the record Monthly claim andcap projection IF MISSEDIF MISSEDIF MISSED Days from election tofiling are non-coveredprovider liability andcannot be billed tothe beneficiary Recertification is notsupported. The benefitperiod is exposed onany medical review Level of care billedexceeds what the recordsupports. Recoupmentarrives post-payment Cap position is not a year-end report. It is a monthly projection per beneficiary,because by the time the cap year reconciles the admissions decisions are already made.
Coverage

Hospice billing in all 50 states + DC.

State-specific Medicaid, MCO, and survey context for every jurisdiction. Click your state for the full local picture.

Hospice billing FAQ

Questions hospice CFOs and owners actually ask.

What is the Medicare hospice aggregate cap amount for FY 2026?

The cap amount for the FY 2026 cap year is $35,361.44 per beneficiary. That is the FY 2025 amount of $34,465.34 updated by the final FY 2026 hospice payment update percentage of 2.6 percent. The figure comes from the CMS FY 2026 Hospice Wage Index and Payment Rate Update final rule published August 5, 2025, effective October 1, 2025.

How quickly must a hospice file the Notice of Election?

Within 5 calendar days after the effective date of the election statement. If the Notice of Election is filed late, Medicare does not cover or pay for hospice care from the election effective date through the filing date. Those days are a provider liability and the hospice may not bill the beneficiary for them. CMS can waive the consequence in defined exceptional circumstances, but the waiver is an exception, not a plan.

When is a face-to-face encounter required for hospice recertification?

A hospice physician or nurse practitioner must have a face-to-face encounter with the patient prior to the 180-day recertification and prior to each subsequent recertification. The FY 2026 final rule clarified the attestation: it must include the signature of the physician or nurse practitioner who conducted the encounter and the date of that signature. A signed and dated clinical note in the medical record can serve as the attestation if it shows the encounter occurred and carries the clinical findings, the date of the visit, the signature and the signature date.

What are the FY 2026 Medicare hospice payment rates?

Routine home care pays $230.83 per day for days 1 through 60 and $181.94 per day from day 61. Inpatient respite care pays $532.48 per day. General inpatient care pays $1,199.86 per day. Continuous home care pays $1,674.29 for a full 24 hours of care, which is $69.76 per hour. These are the final FY 2026 rates before the locality wage index adjustment to the labour portion.

Why do hospices end up owing money back under the cap?

Because the cap is an aggregate test run after the fact. Each beneficiary earns one cap allowance, but a long-stay patient can consume more than one allowance worth of payment: at FY 2026 routine home care rates, cumulative payment for a single beneficiary passes $35,361.44 at roughly day 179. If long-stay mix outruns admissions, aggregate payments exceed aggregate cap allowances and the MAC demands the overage back. The only defence is a monthly cap projection that reaches the admissions conversation while there is still a cap year left to manage.

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Hospice billing by state.

Dedicated Hospice billing and credentialing field guides for 49 states. Each state guide opens into its city-level guides with local payer, Medicaid, and credentialing detail.