Election of the hospice benefit revokes standard coverage for the terminal condition, so anything billed outside it is scrutinised. In Florida that plays out against a specific set of rules rather than a general one.
Claims for Florida providers are adjudicated by First Coast Service Options (JN), which is also who hears the first level of appeal — so an appeal argument that works here works in every state that contractor covers.
At a glance
Coding driver
Per-diem levels of care rather than per-service billing, with the level driven by documented patient need each day.
Medicare contractor
First Coast Service Options (JN)
Medicaid program
Statewide Medicaid Managed Care (SMMC)
Auto injuries
No-fault — auto carrier pays first
What changes in Florida
Medicaid in Florida runs as Statewide Medicaid Managed Care (SMMC) 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.
Florida is a no-fault state. For an auto injury the auto carrier is the payer of first resort, not the health plan, and billing the health plan first produces a denial that looks like a coverage problem but is a sequencing problem.
Florida restricts percentage-based arrangements on Medicaid dollars. Our own pricing in Florida 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.
View pricingHow It Works
Review
We look at your Florida 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.
Hospice Billing in Florida — Frequently Asked Questions
Do hospice billing rules differ in Florida?
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Yes — Florida runs no-fault auto coverage, which changes who pays first for an injury claim. Statewide Medicaid Managed Care (SMMC) is delivered through commercial managed care plans, each setting its own filing window and authorization rules.
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