Hospice runs on four levels of care with different daily rates, a strict election and certification process, and a face-to-face requirement before every benefit period beyond the second — miss one and you've got a billing gap, not just a denial.
Common Billing Challenges
These are the six billing failure points we see most often in hospice programs — and the ones our team resolves systematically from day one.
CMS requires nursing notes to explicitly state the patient couldn't be managed at home — not imply it. Vague symptom-management language is the single biggest reason General Inpatient Care claims get denied.
Using GIP as a convenience admission when a patient really meets caregiver-exhaustion criteria for Inpatient Respite Care is a billing error OIG has specifically targeted — it affects both compliance and the patient's benefit days.
Continuous Home Care requires at least 8 hours of nursing or aide services in a 24-hour period. Many agencies underbill this level simply because they don't document the hours correctly.
The Service Intensity Add-on pays extra when an RN or social worker delivers direct care in the last 7 days of life — but it requires specific revenue code reporting. It isn't automatic.
Missing the face-to-face encounter required before the third and later benefit periods means you can't certify the patient — and a gap in certification means a gap in your billing.
Medicare requires at least 5% of total care hours through volunteers. Hospices that fall below the threshold face reimbursement reductions — track volunteer hours as carefully as clinical hours.
Key Levels & Codes
Our coders hold specialty-specific credentials and train continuously on the levels and rules that drive the most revenue — and the most denials — in hospice billing.
| Level / Code | Description | Common Issue |
|---|---|---|
| RHC | Routine Home Care — most common level | Rate differs day 1-60 vs. day 61+ via SIA calculation |
| CHC | Continuous Home Care — crisis-level service | Requires 8+ hours nursing/aide care in 24 hours, documented |
| IRC | Inpatient Respite Care | Limited to 5 consecutive days per benefit period |
| GIP | General Inpatient Care | Highest daily rate; most documentation requirements |
| SIA | Service Intensity Add-on | RN/SW direct care in last 7 days of life needs specific revenue code |
| 99202–99215 / 99221–99223 | Non-hospice palliative care E/M | Billable only when patient hasn't elected hospice |
Why Rcmaxis
We're not a generalist billing service that added a specialty module. Our team is built around specialty-specific expertise.
Every coder on your account holds the specialty coding credential relevant to hospice billing — not a generic CPC only.
GIP documentation gaps and missed face-to-face recertification deadlines are the biggest drivers of hospice denials — we catch both before they become a billing gap.
Full EHR integration, payer enrollment verification, and charge capture setup in 2 weeks — with zero disruption to your care team.
One point of contact who knows your program, your payers, and your billing history — available for weekly calls and monthly performance reviews.
Month-to-month engagement. We earn your business every month by improving your collections — not by locking you in.
Live visibility into your collections, denial rate, aging AR, and payer performance — updated daily, reviewed monthly with your account team.
Straight answers to what programs usually ask before they switch.
Free revenue assessment for qualified hospice programs. We audit your last 90 days of claims, identify every revenue leak, and show you a clear path to better collections — at no cost.