Hospice Billing in California

Election of the hospice benefit revokes standard coverage for the terminal condition, so anything billed outside it is scrutinised. In California that plays out against a specific set of rules rather than a general one.

Claims for California providers are adjudicated by Noridian Healthcare Solutions (JE), which is also who hears the first level of appeal — so an appeal argument that works here works in every state that contractor covers.

Coding driver

Per-diem levels of care rather than per-service billing, with the level driven by documented patient need each day.

Medicare contractor

Noridian Healthcare Solutions (JE)

Medicaid program

Medi-Cal

Auto injuries

Tort state — health plan sequencing applies

What changes in California

Medicaid in California runs as Medi-Cal and is delivered largely through commercial managed care plans, so most Medicaid claims are adjudicated by an insurer with its own filing window and its own authorization rules rather than by the state.

California prohibits fee splitting generally while authorising percentage-based billing arrangements subject to conditions. Our own pricing in California is set accordingly. That describes what we charge; your own position is a question for your counsel rather than for us.

Where hospice claims fail

Level of care not supported by the daily record
Services billed outside the hospice benefit
Face-to-face recertification encounter missing

We work the claims. You practice medicine.

Coding, claim submission, denial management, and A/R follow-up — with nothing left for your front desk to chase.

Call (409) 880-5990 Book a Free Consultation

View pricing

How It Works

Review

We look at your California hospice denials.

Scope

A written scope and price before any work starts.

Transition

Coding and submission move across without a gap.

Report

Denial causes segmented by payer and provider.