Medicare, Medicaid, room and board, VA and commercial billing for freestanding, hospital-based and multi-location hospices, including hospice physician claims.
Hospice revenue is lost in days, not claims. A notice of election filed on day 6 leaves the days before it unpaid, a face-to-face encounter missed before the third benefit period breaks the recertification, and one returned month holds every claim behind it. Late notices of election or admission caused 11% of hospice and home health payment losses (Luxen billing reviews). Luxen tracks every election, certification and level of care change against the claim, inside the hospice EHR you already use.
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Hospice billing services manage the notice of election, monthly per diem claims on bill type 081X or 082X, level of care revenue codes, visit reporting, hospice physician claims, Medicaid room and board and aggregate cap tracking. For FY 2027, routine home care pays $236.35 a day for days 1 to 60, before wage index adjustment.
Every hospice bills Medicare per day, but the risk sits in different places.
Also billed: services of hospice-employed physicians, nurse practitioners and physician assistants on revenue code 0657, Medicaid hospice, VA Community Care, commercial hospice benefits and patient drug and respite coinsurance.
Most lost hospice revenue is a day of care the hospice delivered but cannot bill, so benefit period checks through eligibility and prior authorization work start at referral, before the election is signed. Dollar figures use FY 2027 national Medicare rates for hospices that report quality data, before wage index adjustment.
| Scenario | Codes | What goes wrong | $ at stake per claim | Luxen audit finding |
|---|---|---|---|---|
| Late notice of election | Bill type 81A or 82A | Filed after day 5, so earlier days are the hospice's liability | $236.35 for every late day at routine home care | Late notices of election or admission caused 11% of hospice and home health payment losses |
| Third benefit period recertification | Occurrence code 27 on 081X or 082X | No face-to-face encounter in the 30 calendar days before the period starts | $186.35 a day, $11,181.00 across a 60-day period | The top three denial reasons accounted for 58% of denied dollars in the average practice |
| Continuous home care day | Revenue code 0652 with G0299 or G0300 | Fewer than 8 hours of care in the day, so the day pays as routine home care | $339.17 on an 8-hour day ($575.52 at $71.94 an hour against $236.35) | Coding and modifier errors caused 21% of denials |
| Service intensity add-on | Revenue code 0651 with G0299 or G0155 | RN or social worker time in the last 7 days of life not reported in 15-minute units | $71.94 an hour, $287.76 for a 4-hour day | Coding and modifier errors caused 21% of denials |
| Respite past day 5 | Revenue code 0655 | Sixth and later consecutive days billed as respite instead of routine home care | $309.63 per day ($545.98 against $236.35) | The top three denial reasons accounted for 58% of denied dollars in the average practice |
| One month missing from the sequence | Bill type 81X or 82X, frequency 2, 3 or 4 | Next claim returned until the prior month finalizes, then resubmitted instead of corrected | A full month, $5,590.50 for 30 days at the day 61+ rate | Duplicate claim denials made up 9% of denials, mostly from resubmitting instead of correcting |
Hospice claims go on the UB-04 (837I), one claim per patient per calendar month, in order. Our certified medical coding team checks each field against the election, the certification and the visit notes.
| Code | Meaning | When it is used |
|---|---|---|
| 081X | Hospice, non-hospital based | Freestanding hospice claims |
| 082X | Hospice, hospital based | Hospital-based hospice claims |
| 8XA | Notice of election | Within 5 calendar days after the election |
| 8XB | Notice of termination or revocation | Within 5 calendar days after a live discharge or revocation |
| 8XC | Change of hospice | Patient transfers to another hospice |
| 8XD | Cancel an election or benefit period | NOE filed in error |
| Frequency 1 to 4 | Admit through discharge, first, continuing and last claim | Each monthly claim in the series |
| Code | What it reports |
|---|---|
| 0651 | Routine home care, paid per day at a higher rate for days 1 to 60 |
| 0652 | Continuous home care, paid per hour with at least 8 hours in the day |
| 0655 | Inpatient respite care, paid for a maximum of 5 consecutive days |
| 0656 | General inpatient care |
| 0657 | Services of hospice-employed or hospice-paid physicians, NPs and PAs, with CPT codes |
| G0299, G0300 | Skilled nursing by an RN or an LPN, each 15 minutes |
| G0155, G0156 | Medical social services and hospice aide services |
| G0151, G0152, G0153 | Physical therapy, occupational therapy and speech language pathology |
| Q5001 to Q5010 | Where care was given, such as Q5001 home, Q5002 assisted living, Q5004 SNF |
From October 1, 2026, the FY 2027 hospice final rule raises base rates 2.3%. Each rate is split into labor and non-labor shares, and the labor share is multiplied by the wage index for the CBSA on the claim.
| Level of care | Revenue code | Hospices reporting quality data | Hospices not reporting |
|---|---|---|---|
| Routine home care, days 1 to 60 | 0651 | $236.35 | $227.11 |
| Routine home care, day 61 on | 0651 | $186.35 | $179.06 |
| Continuous home care, 24 hours | 0652 | $1,726.50 ($71.94 an hour) | $1,658.99 ($69.12 an hour) |
| Inpatient respite care | 0655 | $545.98 | $524.63 |
| General inpatient care | 0656 | $1,231.63 | $1,183.47 |
Inpatient days (general inpatient plus respite) may not exceed 20% of total Medicare hospice days; payment for the excess is refunded. The aggregate cap for the cap year October 1, 2026 to September 30, 2027 is $36,174.75 per beneficiary. The hospice must file its self-determined cap report and repay any overpayment within 5 months after the cap year ends, or payments are suspended.
A hospice claim is only as payable as the dates behind it, so we track each patient's election, notice and certification dates on one calendar.
For elections starting on or after October 1, 2026, every patient gets a written addendum listing the conditions, items, services and drugs the hospice has found unrelated to the terminal illness, within the first 5 days of the election. Plan of care changes that affect it require an update within 3 days.
A hospice physician or hospice nurse practitioner sees the patient no more than 30 calendar days before the third benefit period and every period after. Telehealth is allowed for recertification encounters through December 31, 2027, but not when the patient is in a hospice moratorium area, the hospice is under enhanced oversight, or the practitioner is not enrolled in Medicare. From January 1, 2027, telehealth encounters must be reported on the claim.
It cannot. The NOE is due within 5 calendar days after the election, and days before the filing date are the hospice's liability (42 CFR 418.24). An NOE filed on day 9 leaves the first days unpaid, at $236.35 each for routine home care in days 1 to 60, before wage index. Late notices of election or admission caused 11% of hospice and home health payment losses (Luxen billing reviews).
A hospice NP can perform the face-to-face encounter but cannot certify or recertify terminal illness (Medicare Benefit Policy Manual, Chapter 9, section 20.1). A benefit period without a valid physician recertification is not payable on review. The top three denial reasons accounted for 58% of denied dollars in the average practice (Luxen billing reviews).
After an MA enrollee elects hospice, Medicare pays the hospice through the fee-for-service contractor (Medicare Benefit Policy Manual, Chapter 9, section 20.4). Claims sent to the plan are denied and age toward timely filing. Eligibility and coverage errors caused 24% of denials (Luxen claim audit).
It does not. For Medicaid residents, the state pays the hospice at least 95% of the facility rate, and the hospice pays the facility (Social Security Act 1902(a)(13)(B)). An unreconciled pass-through leaves the hospice paying days it was never paid for. Underpayments against contracted rates appeared on 7.8% of paid claims (Luxen claim audit).
Codes for debility and failure to thrive are not accepted as the principal diagnosis on hospice claims, and the claim is returned (CMS MLN MM13882). A returned month also holds every later month for that patient. Coding and modifier errors caused 21% of denials (Luxen claim audit).
We run the revenue cycle from eligibility to zero balance inside the practice management system you already use. How full-service billing works.
Certified coders review charges against your documentation and payer rules before the claim goes out, so the denial is prevented rather than appealed. Medical coding.
Aged and denied claims are worked to resolution, then the upstream cause is fixed so the same claims stop coming back. Denials and AR recovery.
Benefits are verified and authorizations secured before the appointment, which is the cheapest place in the cycle to stop a denial. Eligibility and prior authorization.
Statements, balance questions and payment plans are handled by the same team that worked the claim. Patient billing.
Payer enrollment and re-credentialing are tracked through to approval, so a lapsed credential never quietly stops payment. Credentialing.
A HIPAA-trained front-office assistant working inside your EHR on calls, scheduling, intake and referrals, alongside the billing team. Medical virtual assistant.
We work inside the systems your hospice already runs, with no migration.
We sign the BAA before access.
2 weeks
from a signed BAA to our team working your claims
About 3 weeks
to the first recovered payments on aged AR
20+ years
combined billing and coding experience
Luxen billing reviews, 410 practice billing reviews, Jan 2025 to Jun 2026:
Luxen client data, 38 client practices, Jan 2024 to Jun 2026:
Election statements, physician certifications, and benefit periods were tracked in separate places. Luxen created one patient-level calendar and reduced hospice claims held for missing documentation from $158,000 to $24,000.
Director of Operations, community hospice provider
Changes between routine, respite, and continuous care were not always reflected in billing on the correct service date. Luxen reconciled the daily census and recovered $77,500 in missed or corrected level-of-care charges.
Revenue Cycle Manager, multi-county hospice organization
Full engagements are written up in our dental practice case study and our ambulance billing case study.
The election moves payment for the terminal illness to the hospice. Everything else still needs the right payer and modifier.
The hospice bills Medicare. Services by physicians, NPs and PAs employed or paid by the hospice go on the hospice claim under revenue code 0657 with CPT codes.
When an MA enrollee elects hospice, Original Medicare pays the hospice through the fee-for-service contractor, not the plan.
Medicare does not pay room and board. For dual eligible residents, state Medicaid pays the hospice at least 95% of the rate it would have paid the facility, and the hospice pays the facility under their written agreement.
Drug coinsurance is 5% of the drug cost, capped at $5 per prescription, during routine and continuous home care. Respite coinsurance is 5% of the Medicare respite payment per day, capped at the inpatient hospital deductible. Our patient billing team sends these statements.
Since May 13, 2026, CMS has blocked new Medicare enrollment of hospices and hospice practice locations nationwide, for six months with possible six-month extensions. A change in majority ownership within 36 months of initial enrollment or the last majority ownership change counts as a new enrollment, so it is blocked too.
New hospices and qualifying ownership changes face claims medical review, such as prepayment review, lasting 30 days to 1 year. It began July 13, 2023 in Arizona, California, Nevada and Texas, and added Georgia and Ohio on December 30, 2025. See our state guides for Arizona medical billing, California medical billing and Texas medical billing. Our denial and AR recovery team answers additional documentation requests before the deadline.
Practices that reviewed AR ageing monthly carried 12 fewer days in AR, and every 10 days removed from AR released a median $41,000 in cash for practices collecting $1.5M to $3M a year (Luxen billing reviews).
Each of those six is worked every month in our hospice revenue cycle management engagement, alongside the aggregate cap forecast.
3% to 6% of collections
Luxen's pricing generally falls between 3% and 6% of collections, depending on claim volume, specialty, payer mix, and how much of the revenue cycle your practice hands over.
Higher-volume practices usually land toward the lower end. Smaller or more complex practices land higher because there is more work per account. There is no setup fee and no exit fee, and the agreement runs month to month with 30 days notice.
A lower fee attached to weak billing is still expensive. The number that matters is what your collections do after you hire someone.
Luxen charges 3% to 6% of collections, depending on census, payer mix and room and board volume. No setup or exit fee.
| Service line | Monthly collections | Luxen at 3% | Luxen at 6% |
|---|---|---|---|
| Medicare hospice per diem claims | $120,000 | $3,600 | $7,200 |
| Medicaid hospice and room and board | $20,000 | $600 | $1,200 |
| VA, commercial and patient coinsurance | $10,000 | $300 | $600 |
| Total | $150,000 | $4,500 | $9,000 |
| Cost | In-house billing | Luxen |
|---|---|---|
| Cost basis | Fully loaded in-house billing cost 7.9% of collections for practices under $2M, about $11,850 a month here | $4,500 to $9,000 a month ($54,000 to $108,000 a year) |
| When a biller leaves | Open biller roles took a median 67 days to fill, while NOE deadlines keep running | No gap in coverage |
| Denial follow-up | 42% of practice managers said nobody owns denial follow-up full time | A named owner for every returned or denied claim |
| Terms | Employment commitments | Month to month, 30 days notice |
| Partner type | NOE and certification tracking | Cap and room and board work | Terms |
|---|---|---|---|
| In-house billing | One or two people, often split with intake | Often left until year end | Payroll and turnover |
| Generalist billing company | Physician claim focus | Rarely included | Often annual |
| Specialty hospice billing company | Hospice experience | Sometimes included | Some charge setup fees |
| EHR vendor RCM | Vendor workflows | Limited | Bundled with software |
| Luxen | Daily NOE, NOTR and benefit period tracking by certified coders | Monthly cap and room and board reconciliation | Month to month, 30 days notice |
Compare medical billing companies on these points, or see what full-service medical billing covers.
A 30-minute look at your AR ageing, denial reasons and payer mix. You leave knowing what is recoverable, what we would work first and what it would cost.
We sign a business associate agreement before anyone touches your system. Your named team then works inside the practice management system and clearinghouse you already use. Nothing is migrated, and claims are being worked within two weeks of the signed BAA.
Aged and denied claims come first because that is revenue you have already earned. Most practices see the first recovered payments inside three weeks.
Once the backlog is moving, we take over the agreed part of the daily cycle: eligibility, coding review, submission, posting, denials and patient balances.
You know who owns your claims. The team works inside the practice management system and EHR you already run, with no migration.
Claims are coded by certified coders against your documentation and payer rules. Automation handles the repetitive checks so people spend their time on the claims that need judgment.
We sign a business associate agreement before accessing protected health information, and access is limited to the named people on your account.
We look at your AR ageing, volume, payer mix and denial profile first, then tell you what we believe is recoverable and what it would cost.
A billing company is a poor fit if you are not willing to share visibility into your billing, if the vendor uses a rotating pool of people who never learn your practice, or if it cannot explain why your claims are being denied. Be wary of anyone promising large collection increases before they have seen your AR ageing. The right partner makes your revenue cycle more visible, not less.
The hospice files a notice of election within 5 calendar days of the election, then bills Medicare one claim per patient per month, in sequence, on bill type 081X or 082X, with each day paid at its level of care. For FY 2027, routine home care pays $236.35 a day for days 1 to 60 and $186.35 after, before wage index adjustment.
Luxen charges 3% to 6% of collections, based on census, payer mix and room and board volume. A hospice collecting $150,000 a month would pay $4,500 to $9,000. There is no setup or exit fee, and terms are month to month with 30 days notice.
Work starts about 2 weeks after the BAA is signed, and first recovered payments arrive in about 3 weeks. We start with open NOEs, returned months that hold later claims, and recertifications coming due, then work older AR.
Yes. We work inside your hospice EHR and your Medicare contractor's direct data entry access, so there is no migration. Of practices that changed systems, 71% said collections dipped for at least six months after the switch (Luxen Practice Manager Survey 2026).
Under 42 CFR 424.550(b), if a hospice changes majority ownership within 36 months of its initial Medicare enrollment or its last majority ownership change, the provider agreement and billing privileges do not transfer. The new owner must enroll as a new hospice and get a state survey or accreditation. During the moratorium that began May 13, 2026, that new enrollment cannot proceed.
Thirty minutes, no deck and no fee. We look at what is sitting past 90 days and where your denials cluster, and you leave knowing what is recoverable, what we would work first, and what it would cost.
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