Hospice Care

Eligibility, approvals,and care levels,in agreement.

Hospice teams answer to traditional Medicare, Medicare Advantage, Medicaid, and commercial plans at once. Circle helps teams track initial and continued authorization windows, verify care-level changes against approvals, and keep election and certification timelines ready for review.

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100%

Chart review coverage

Admission approval does not cover every day or change in care level. Circle keeps approvals, eligibility evidence, and claims aligned across every payer.

Reimbursement structure

Traditional Medicare pays per diem across four levels of care within 90-day and 60-day benefit periods. Medicare Advantage and commercial plans often set their own authorization windows, care-level approvals, and covered-item terms. Medicaid adds state-specific authorization and dual-eligible rules.

Common criteria evaluated

Medicare Hospice CoPs
Hospice LCDs
State Medicaid hospice rules
Medicare Advantage and commercial review guidelines
HOPE reporting
The Joint Commission (TJC)
State licensing

How it works, in the daily work.

Authorization tracking

Commercial plan, routine home care

Initial authorization
Approval period active
Complete
Continued-care review
Due in 5 days, updated notes needed
Review needed
Level of care change
Routine home care to inpatient respite
Review needed
Respite approval
Not found for this level of care
Missing

Built into every review.

Authorization and review tracking

Initial and continued review periods, approval dates, and level-of-care changes followed before claims go out.

Payer-specific criteria

Prognosis documentation and decline evidence organized against the criteria of the payer on file.

Level-of-care reconciliation

Routine home care, continuous care, respite, and general inpatient checked against approvals and contract terms.

Election and certification timelines

Benefit periods, face-to-face encounters, election documents, and physician signatures tracked so nothing is late.

One plan across the team

Notes from every discipline compared against the plan of care, with HOPE tracked from submitted to accepted.

Clinicians decide eligibility

Circle organizes the evidence. Eligibility decisions and physician attestations stay with clinicians, and it works alongside the EMR.

What customers have measured.

100%

Chart review coverage

70%

Less time to a compliant note, expanding clinical capacity

As reported by Circle customers

2M+

Records processed

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Solution

Compliance and QA

Every active chart reviewed while the client is still in care.

Solution

Pre-Bill and Record Reviews

Documentation gaps caught before billing, and records ready for payer reviews.

Solution

Documentation

Notes, plans, and assessments guided by what reviewers expect.

Know what each payer expects. Act before revenue is at risk.

See how Circle fits alongside the systems already in place.

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