Start-up and newly certified hospices working through CMS's Provisional Period of Enhanced Oversight and prepayment medical review.
Hospice Billing Services in Nevada That Get Every Covered Day Paid
Nevada Medical Billing runs your entire hospice revenue cycle, from the Notice of Election to the final remittance, so every covered day is billed, paid and audit-ready. We file NOEs and NOTRs inside the 5-day window, bill all four levels of care at FY2027 rates, track your aggregate cap monthly and defend claims under Nevada's Expanded Prepayment Review.
No contract changes required for the audit. We review 90 days of claims, NOEs and AR and show you exactly where revenue is leaking.
Last updated: October 19, 2026
98%+
first-pass clean claim rate
24 hours
NOE/NOTR filed within 24 hours of receipt
<30 days
Days in AR driven under 30, denial rate held under 5%
HIPAA
HIPAA-compliant, signed BAA, serving Las Vegas, Henderson, Reno, Carson City and rural Nevada
What Hospice Billing Services Cover,
and Why Hospice Billing Breaks General Billers
Hospice billing services are the outsourced management of a hospice agency's revenue cycle under the Medicare hospice benefit, Medicaid and commercial plans. That covers election paperwork, the Notice of Election (NOE), monthly per diem claims for each level of care, the Notice of Termination or Revocation (NOTR), aggregate and inpatient cap tracking, denial and ADR appeals, and payment posting.
Hospice billing is not home health or physician billing. Medicare pays a hospice a daily rate for every day a patient is under election, at one of four levels of care, and limits total payments per beneficiary through the aggregate cap. One late NOE or one wrong level of care can wipe out days of revenue that can never be rebilled.
Built for Every Nevada Hospice,
From First Admission to Multi-Site Census
Established community hospices in Clark, Washoe and Carson City that need steady cash flow and cap control as census grows.
Rural and frontier hospices in Elko, Nye, Lyon and Churchill counties where long travel times inflate continuous care documentation risk.
Multi-location and hospital-based hospice programs that need one consolidated AR, denial and cap report across sites.
Hospices serving nursing-facility residents that bill Nevada Medicaid room and board alongside Medicare hospice days.
Every Nevada Hospice Payer Billed: NGS Medicare,
Nevada Medicaid, MA, VA and Commercial
Original Medicare through National Government Services (NGS), the Jurisdiction 6 home health and hospice MAC for Nevada; Nevada Medicaid fee-for-service and its managed care organizations; Medicare Advantage plans for non-hospice and supplemental claims; VA Community Care; and commercial plans with hospice riders. Each payer gets its own timely-filing calendar, so no claim ages past its deadline.
8 Revenue Leaks Draining Nevada Hospices,
and How We Seal Each One
Nevada is one of the most scrutinized hospice markets in the country. Legitimate agencies now carry the documentation burden created by bad actors, and every billing gap is more likely to be caught. These are the leaks we see most often.
| Pain point | What it costs you | How Nevada Medical Billing fixes it |
|---|---|---|
Late or rejected NOE | Days from election to NOE acceptance are non-covered and cannot be billed to the patient | NOE keyed same day, acceptance confirmed in DDE within 24 hours, KT exception requests filed when they qualify |
Expanded Prepayment Review (EPR) | Claims held for medical review; cash flow stalls for weeks | Pre-bill chart audit of CTI, F2F, election statement and visit notes before the claim drops |
Election Statement Addendum now 100% | Missing or late addendum is a compliance finding on every admission since Oct 1, 2026 | Admission checklist flags addenda not delivered inside the 5-day assessment window or not updated within 3 days of a change |
Wrong level of care | CHC or GIP denied and downcoded to RHC, losing $1,000+ per day | Level-of-care validation against nursing notes, hours and symptom documentation |
Aggregate cap overpayment | Refund demand months after year-end, often six figures | Monthly cap liability projection per beneficiary at the FY2027 cap of $36,174.75 |
Live discharges and revocations | Missed NOTR, transfer errors, SSVI red flags | NOTR filed in 5 days; live discharge rate monitored against peers |
Staff turnover | Lost billing knowledge, backlogged AR over 90 days | A dedicated hospice billing team that already knows NGS, DDE and your EMR |
Nevada Medicaid disruption | State enrollment moratorium and on-site reviews of Medicaid-enrolled hospices | Medicaid enrollment, revalidation and room-and-board documentation kept review-ready |
Nevada Hospices Are Under a Microscope:
Clean Claims Are Your Best Defense
CMS placed new, reactivating and change-of-ownership hospices in Nevada under a Provisional Period of Enhanced Oversight in July 2023, then extended prepayment review to existing Nevada hospices on September 17, 2024 (CMS). In June 2026 the Nevada Health Authority paused new state hospice licenses, set a Medicaid enrollment moratorium and announced on-site reviews of every Medicaid-enrolled hospice (KTNV). For a compliant hospice, the winning response is clean, defensible claims on day one, which is exactly what we build.
End-to-End Hospice RCM Services That Protect
Cash Flow From Admission to Final Payment
One partner covers every step of the hospice revenue cycle, so nothing falls between intake, clinical and finance.
- 01
Eligibility and Benefit Period Checks That Stop Rejections Before Admission
We check Medicare eligibility, prior hospice elections and the current benefit period (90, 90, then unlimited 60-day periods) before admission. That prevents duplicate-election rejections and catches patients still enrolled with another hospice or a Medicare Advantage plan.
- 02
NOE and NOTR Filing in 24 Hours, Not 5 Days
We submit the NOE (type of bill 081A) within 5 calendar days of the election date and the NOTR (081B) within 5 days of a live discharge, revocation or transfer. Every NOE is tracked to acceptance, not just submission.
- 03
Election Statement Addendum Compliance on 100% of Admissions
We confirm each election statement carries the required elements, the attending physician choice and the updated addendum language now required for 100% of admissions.
- 04
Hospice Billing and Coding Services That Defend Your Terminal Diagnosis
Our coders assign the principal terminal diagnosis and related conditions in ICD-10-CM, avoiding non-specific codes Medicare rejects as principal, such as debility and adult failure to thrive. We report revenue codes, site-of-service Q-codes and visit G-codes that drive the Service Intensity Add-on (SIA).
- 05
Level-of-Care Billing That Captures the Full RHC, CHC, Respite and GIP Rate
Routine Home Care, Continuous Home Care, Inpatient Respite Care and General Inpatient Care are billed with the right revenue codes, hours, and two-tier RHC rate (days 1–60 vs. 61+).
- 06
Monthly Claims Out Within 3 Business Days of Month-End
Final claims (081X–082X) go out within 3 business days of month-end, in sequence, with CTI, recertification and face-to-face dates validated before release. Starting January 1, 2027, we append G0679 when the face-to-face encounter was done by telehealth.
- 07
Aggregate and Inpatient Cap Management That Ends Year-End Refund Shocks
We project each beneficiary's cap liability monthly, model streamlined vs. proportional methods, and track the 20% inpatient day limit so you reserve cash before a refund demand arrives.
- 08
Nevada Medicaid Room and Board Billing, Reconciled to the Dollar
For dual-eligible residents in Nevada nursing facilities, we bill Nevada Medicaid room and board, reconcile pass-through payments and keep the facility agreement documentation in order.
- 09
Denial Management That Holds Denials Under 5%
Rejections are corrected in DDE the same day; denials are appealed through redetermination, reconsideration and ALJ levels with the clinical record organized for the reviewer.
- 10
Hospice Billing and Collections That Drive AR Under 30 Days
We work every open balance by payer and age bucket, chase underpayments against the FY2027 rate and wage index, and post payments and ERAs daily.
- 11
Credentialing and Enrollment With Zero Enrollment-Gap Denials
PECOS updates, Nevada Medicaid enrollment and revalidation, and MA and commercial contracting so no claim is denied for an enrollment gap.
- 12
Monthly KPI Reporting That Shows Exactly Where Your Money Is
Monthly KPIs: days in AR, NOE timeliness, denial rate by reason, cap exposure, live discharge rate, and HQRP submission status (HOPE and Hospice CAHPS) so you avoid the 4-point payment penalty.
Billing Medicare for Hospice Services in FY2027: The Rates,
Rules and Cap We Bill To
For care on or after October 1, 2026, Medicare raised hospice rates 2.3% and set the aggregate cap at $36,174.75 per beneficiary (CMS fact sheet). CMS then corrected a wage index error on September 30, 2026, trimming national rates by a few cents (Tortolano & Co.). We load the corrected rates and Nevada CBSA wage indexes, then audit October remittances against them.
FY2027 Medicare Hospice Rates by Level of Care, Corrected September 30, 2026
| Level of care | Revenue code | FY2027 rate | Unit |
|---|---|---|---|
Routine Home Care, days 1–60 | 0651 | $236.33 | per day |
Routine Home Care, day 61+ | 0651 | $186.33 | per day |
Continuous Home Care | 0652 | $1,726.16 | per 24 hours (8-hour minimum, billed hourly) |
Inpatient Respite Care | 0655 | $545.93 | per day (up to 5 consecutive days) |
General Inpatient Care | 0656 | $1,231.51 | per day |
Rates are national before the wage index adjustment; your Las Vegas, Reno or rural Nevada payment differs. Hospices that miss quality reporting get the 2.3% update minus 4 points, a 1.7% cut (CMS).
$236.33
Routine Home Care, days 1–60
per day · 0651
$186.33
Routine Home Care, day 61+
per day · 0651
$1,726.16
Continuous Home Care
per 24 hours (8-hour minimum, billed hourly) · 0652
$545.93
Inpatient Respite Care
per day (up to 5 consecutive days) · 0655
$1,231.51
General Inpatient Care
per day · 0656
9 Medicare Hospice Billing Rules
That Decide Whether You Get Paid
| Rule | Requirement | Billing impact if missed |
|---|---|---|
Notice of Election | Accepted within 5 calendar days of election | Days before acceptance are hospice-liable, non-billable |
NOTR | Within 5 calendar days of discharge or revocation | Patient blocked from other Medicare services; claim edits |
Certification of Terminal Illness | Prognosis of 6 months or less, signed per benefit period | Claim denied for the whole period |
Face-to-face encounter | Before the 3rd benefit period and every one after; telehealth allowed through Dec 31, 2027 | Recertification invalid; patient must be discharged |
Telehealth F2F code | G0679 on claims from Jan 1, 2027 (HPS) | Claim and audit mismatch |
Election Statement Addendum | Every admission, inside the 5-day assessment window; updated within 3 days of a change | Compliance finding and SSVI scrutiny |
Service Intensity Add-on | RN and social worker visits in the last 7 days of life | Under-payment if visit G-codes are wrong |
Aggregate cap | $36,174.75 per beneficiary for the cap year ending Sep 30, 2027 | Overpayment refund |
Inpatient cap | Inpatient days limited to 20% of total days | Excess inpatient payment recouped |
Your Hospice Cap Will Hit
Sooner in FY2027. Here Is Why.
The cap rose about $813 while every billed day accrues against it 2.3% faster, so long-stay programs reach the ceiling sooner (ASP RCM). Nevada programs with high RHC day-61+ volume should model this now, not at year-end.
Hospice Billing Services That Handle Denials,
ADRs and Audits Before They Cost You
Most hospice denials trace back to six documentation gaps, and each one is preventable before the claim leaves your office.
| Denial driver | Root cause | Our prevention step |
|---|---|---|
Eligibility not supported | Narrative does not show decline toward a 6-month prognosis | Pre-bill review of CTI narrative, LCD criteria and functional scores |
Missing or unsigned CTI/recert | Physician signature or date outside the window | Signature and date tracker per benefit period |
Face-to-face missing or late | Encounter not done before the 3rd period | F2F due-date alerts 30 days ahead |
Level of care not supported | CHC hours under 8 or GIP without uncontrolled symptoms | Hours and symptom audit on every CHC and GIP day |
Late NOE | Intake delays, DDE errors | Same-day NOE entry and acceptance check |
Non-hospice spending | Part B or D claims for conditions related to the terminal diagnosis | Addendum review and related/unrelated coordination with outside providers |
EPR, PPEO and ADR Responses Indexed for Faster Payment Release
We prepare and submit records for every review type Nevada hospices face: Additional Documentation Requests (ADR), Targeted Probe and Educate (TPE), the Provisional Period of Enhanced Oversight (PPEO), Expanded Prepayment Review (EPR), UPIC, SMRC, RAC and CERT. Each response is indexed so the reviewer finds the CTI, F2F, election statement, plan of care and visit notes in seconds.
Appeals From Redetermination to ALJ, Tracked Until Paid
We file redeterminations with NGS within 120 days, reconsiderations with the QIC within 180 days, and support ALJ hearings with a clean, chronological record. You see every appeal's status in your monthly report.
HIPAA-Compliant Hospice Billing
With a Signed BAA From Day One
We sign a Business Associate Agreement, work inside your EMR with role-based access, and keep PHI in encrypted, U.S.-based systems. Every user is logged, access is reviewed quarterly, and credentials are removed the day a team member leaves.
Outsource Hospice Billing in 30
Days Without Missing a Single NOE
You can switch billing partners in about 30 days without stopping cash flow. Here is the five-step transition.
Free hospice billing audit (week 1)
We review 90 days of NOEs, claims, denials and AR and give you a written revenue-leak report.
Access and setup (week 1–2)
BAA signed, EMR and DDE access granted, NGS and Nevada Medicaid payer profiles confirmed, FY2027 rates and wage indexes verified.
Parallel run (week 2–3)
Our team works alongside your current biller so no NOE or monthly claim is missed during handoff.
Backlog cleanup (week 3–6)
Aged AR, open denials and unfiled claims are worked in priority order by dollar value and timely-filing risk.
Steady state (ongoing)
Daily NOE/NOTR and DDE checks, monthly claims, weekly AR calls, monthly KPI and cap report with a named account manager.
AI-Powered Hospice Billing That Catches
Errors Before Medicare Does
We use automation where it removes errors and keep people where judgment matters.
Pre-bill scrubbing: rule engines check CTI dates, F2F timing, benefit periods, level-of-care hours and revenue code combinations before release.
Documentation gap detection: AI flags missing signatures, absent addenda and visit notes that do not support CHC or GIP days.
Denial pattern analytics: remittance codes are grouped by root cause so fixes go upstream to intake and clinical.
Cap forecasting: beneficiary-level projections update as days accrue.
Every flag is reviewed by a certified hospice biller before anything is submitted. Automation speeds the work; it never signs off on a claim.
We Work Inside Your Hospice EMR,
So Clinicians Change Nothing
Our billers work inside the leading hospice platforms, including WellSky, Axxess Hospice, HCHB, MatrixCare and FireNote, plus NGS DDE. No new software, no retraining, no duplicate data entry.
- WellSky
- Axxess Hospice
- HCHB
- MatrixCare
- FireNote
- NGS DDE
Outsource Hospice Billing or Keep
It In-House? The Side-by-Side Math
Outsourcing wins when NOE timeliness, denial rates or AR days slip, or when one biller holds all your billing knowledge.
| Factor | In-house hospice biller | Nevada Medical Billing |
|---|---|---|
Cost | Salary, benefits, training, software, backup coverage | One fee tied to collections, typically less than one full-time biller's loaded cost |
Coverage | Gaps during PTO, sickness, turnover | Team coverage; NOEs filed every business day |
Regulatory updates | Learned ad hoc | FY2027 rule, correction notice, G0679 and addendum built into workflows |
Audit readiness | Reactive to ADRs | Pre-bill audit on every claim; EPR-ready records |
Cap visibility | Year-end surprise | Monthly projection |
Reporting | Varies | Monthly KPI dashboard and named account manager |
Hospice Billing Pricing:
You Pay Only When You Get Paid
We price as a percentage of collected revenue, so we are paid only when you are. Fees fall within the industry-standard 4%–8% of net collections, scaled to census, payer mix and backlog, with no setup fee and no long-term lock-in. NOE/NOTR management, cap projections and monthly KPI reports are included, not upsold. Ask for a fixed quote after your free audit.
HIPAA compliant · Signed BAA · No obligation
7 Questions to Ask Before Hiring
Any Hospice Billing Company
When comparing top Medicare hospice billing companies, ask every vendor these questions:
Do you bill hospice only, or is hospice one line on a general list?
What is your NOE acceptance rate within 5 days, and how do you prove it?
Have you loaded the corrected FY2027 rates and Nevada wage indexes?
How do you project the aggregate cap, and how often?
Who handles ADRs and EPR responses, and at what extra cost?
Do you work in my EMR and DDE, or require new software?
Can I speak with a current Nevada hospice client?
Why Nevada Hospices Choose a Local
Billing Partner Over National Vendors
Hospice-specific team trained on the Medicare hospice benefit, NGS processes and Nevada Medicaid.
Local accountability with a Nevada account manager and same-day response.
Audit-ready by design for PPEO, EPR and state on-site reviews.
Transparent reporting on NOEs, denials, AR and cap every month.
Hospice Billing Services Reviews:
The Numbers Our Clients Hold Us To
Hospice leaders judge billing partners on results, not adjectives. Every engagement is measured monthly against six service levels: 98%+ first-pass clean claims, 100% of NOEs and NOTRs filed within 24 hours of receipt, denials under 5%, days in AR under 30, monthly claims out within 3 business days of month-end, and ADR responses submitted at least 5 days before the deadline. Miss one and you see it in the report, with the fix.
Hospice Billing FAQs: Straight
Answers for Nevada Hospice Leaders
Can't find what you need? Our Nevada team answers every question before you commit.
Eligibility checks, NOE and NOTR filing, election statement and addendum review, hospice coding, monthly claims for all four levels of care, cap tracking, room and board billing, denial appeals, ADR and EPR responses, AR follow-up, payment posting and monthly reporting.
Hospice is paid a per diem for each day under election at one of four levels of care, subject to an annual aggregate cap. Home health is paid per 30-day period under PDGM. Hospice also depends on the NOE, CTI and face-to-face rules that do not exist in home health.
The days from the election date until Medicare accepts the NOE are non-covered and the hospice cannot bill the patient for them. A narrow exception exists for circumstances outside the hospice's control. We file NOEs the same day we receive them to avoid this loss.
Nationally, after CMS's September 2026 correction: $236.33 per day for RHC days 1–60, $186.33 for day 61+, $1,726.16 per 24 hours of CHC, $545.93 for respite and $1,231.51 for GIP. The cap is $36,174.75. Nevada payments are adjusted by local wage index.
Yes. We correct rejections in DDE the same day and appeal denials through redetermination, reconsideration and ALJ levels. We also prepare ADR, TPE, PPEO and Expanded Prepayment Review records.
Yes. New and change-of-ownership hospices in Nevada face prepayment medical review. We build audit-ready charts and claims from the first admission so payments are released as fast as review allows.
Yes. We bill Nevada Medicaid hospice days and nursing-facility room and board for dual-eligible patients, and keep enrollment and revalidation current during the state's review period.
Yes. You can outsource billing and collections alone, or add coding, credentialing and cap management as your census grows.
Most hospice billing companies charge a percentage of collections. We quote a fixed rate after a free audit of your claim volume, payer mix and backlog.
About 30 days, with a parallel run so no NOE or monthly claim is missed. Most hospices see cleaner claims within the first billing cycle.
Stop Losing Hospice Revenue to Late NOEs,
Denials and Cap Surprises
Book a free hospice billing audit. In one call we show you unbilled days, denial patterns and your FY2027 cap exposure, with a plan to fix them.