Election of the hospice benefit revokes standard coverage for the terminal condition, so anything billed outside it is scrutinized. In West Virginia that plays out against a specific set of rules rather than a general one.
Medicare home health and hospice claims for West Virginia agencies go to CGS Administrators (J15 home health and hospice), the home health and hospice contractor, not the Part A/B contractor, and it also hears the first level of appeal.
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
CGS Administrators (J15 home health and hospice)
Medicaid program
Mountain Health Trust
Auto injuries
Tort state — health plan sequencing applies
What changes in West Virginia
Medicaid in West Virginia runs as Mountain Health Trust 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.
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 West Virginia 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 West Virginia — Frequently Asked Questions
Do hospice billing rules differ in West Virginia?
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Yes. Medicaid runs as Mountain Health Trust, delivered largely through commercial managed care plans. So most West Virginia Medicaid claims are adjudicated by an insurer with its own filing window, its own authorization rules, and its own appeal path — not by the state. Nationally about 78% of Medicaid beneficiaries sit in comprehensive managed care, and five companies hold roughly half of that enrollment.
Which Medicare contractor handles West Virginia hospice claims?
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CGS Administrators (J15 home health and hospice). Home health and hospice claims have their own Medicare contractors, separate from the Part A/B contractor for West Virginia. It processes the claims, publishes the local coverage determinations that bind you, and hears the first level of appeal.
What makes hospice claims deny in West Virginia?
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The specialty causes first: level of care not supported by the daily record; services billed outside the hospice benefit; face-to-face recertification encounter missing. On top of those, West Virginia Medicaid runs through commercial plans, so filing windows and authorization rules vary by plan rather than by program.
How are auto injuries handled for hospice in West Virginia?
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West Virginia is a tort state for auto injuries, so standard coordination of benefits applies rather than an auto carrier taking first position. The injury still has to be identified at registration, because liability coverage may be primary for the related care.
How do you price hospice billing in West Virginia?
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A percentage of collections, banded by practice size, with a monthly minimum so a smaller practice is served properly rather than quoted a rate that does not cover the work. The West Virginia rate card is on the state page.
Are your hospice coders certified?
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Yes. All coding is performed by certified coders credentialed through the AAPC or AHIMA, working from the documentation you provide. Per-diem levels of care rather than per-service billing, with the level driven by documented patient need each day.
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