Hospice Pre-Bill Provided by SMART Healthcare Compliance Resources

Top Payment Denial Reasons—

• Not Hospice Appropriate - 39%

• Election Statement Was Missing BFCC-QIO Information - 10%

• No Plan of Care Submitted - 9%

• No Valid Election Statement Addendum Submitted - 8%

• Face-to-Face Encounter Requirements Not Met - 7%

In an era of intensifying CMS scrutiny and complex Medicare regulations, submitting a hospice claim without rigorous preliminary oversight is a significant financial and operational liability. Pre-bill auditing is a proactive compliance mechanism that reviews clinical documentation, eligibility metrics, and claims data before they are submitted to Medicare or other payors.

Rather than waiting for a post-payment review to expose vulnerabilities, pre-bill auditing acts as an agency's first line of defense. It ensures that every claim is fully supported by precise clinical documentation, perfectly aligns with the Medicare Conditions of Participation, and satisfies every requirement of the Conditions of Payment.