Hospice · NOE & CAP
Hospice payment starts with a timely Notice of Election and ends at the aggregate cap. Cardinal BPS watches the notice, the coding, and the length of stay so a benefit period is not lost on a filing date or repaid at the end of the year.
01
Medicare expects the Notice of Election within five calendar days of the election. A late notice makes the days from the election through the day before it is filed non-covered. The election date, attending physician, and principal diagnosis have to be right the first time.
02
In a cap year, November 1 through October 31, Medicare payments cannot exceed the allowed amount for the beneficiaries served. What is over the cap is repaid. Length of stay is what pushes a hospice there.
03
A rejected notice and a record that cannot support the terminal prognosis are different failures. They land on the same claim. The notice, the diagnoses, and the clinical story have to describe one patient.
What we look at
Where this lives in the work
01
Notice of Election timing, claim submission, and follow-up so a late filing or a rejected notice is caught before the days are written off.
Revenue Cycle Management02
Principal diagnosis and related conditions that match the terminal illness the benefit is being paid for.
Medical Coding03
Documentation of decline and prognosis that can stand up to medical review, not only to the first claim.
Clinical Documentation04
Length of stay and inpatient days against the yearly ceiling, so a repayment is not a surprise at the end of the cap year.
Healthcare Consulting