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Activities of Daily Living (ADL) Assessment

Measuring self-care ability to determine service needs

Home Care

Aggregate Cap Calculation

Medicare's per-beneficiary ceiling on annual hospice payments

Reimbursement

APU Penalty Exposure

Financial risk of a 4-point Annual Payment Update reduction

Quality & Reporting

Attending Physician vs. Hospice Medical Director Role

Distinct responsibilities of the two physician roles

Clinical

Authorization Denial Management

Preventing, tracking, and appealing coverage denials

Billing & RCM

Benefit Period Election

Patient's formal choice to receive the Medicare hospice benefit

Clinical

Bereaved Family Survey Weighting

CMS adjustments applied to CAHPS responses before public reporting

Quality & Reporting

Bereavement Services Compliance

Requirements for family and caregiver support before and after death

Clinical

CAHPS Hospice Survey Methodology

Vendor-administered caregiver experience survey for the HQRP

Quality & Reporting

Cap Period Exposure

Risk of exceeding the aggregate cap during a cap year

Reimbursement

Care Compare Public Reporting

Medicare.gov tool publishing hospice quality data and star ratings

Quality & Reporting

Census Management

Managing average daily census composition within payment caps

Billing & RCM

CHC Minimum Hours Threshold

Eight-hour minimum to bill a day as Continuous Home Care

Reimbursement

Claims Scrubbing in Hospice Billing

Automated pre-submission review against payer edits

Billing & RCM

Condition of Participation (CoP) Violation

Condition-level deficiency that threatens enrollment

Compliance

Dual Eligibility and Hospice

Coverage mechanics for beneficiaries in both Medicare and Medicaid

Billing & RCM

EVV Compliance Standards

Federally mandated electronic verification of Medicaid home visits

Home Care

High Visit Low Day Labor (HVLDL)

End-of-life visit labor concentration and its cost dynamics

Reimbursement

Home Care Aide Scope of Practice

Tasks a paraprofessional caregiver may legally perform

Home Care

Homemaker vs. Personal Care Aide

Hands-off household tasks vs. hands-on ADL assistance

Home Care

HOPE Admission vs. Update vs. Discharge

Three HOPE record types and when each is required

Quality & Reporting

HOPE Assessment

CMS standardized patient assessment for the HQRP

Quality & Reporting

HOPE Item Set

Standardized data elements that make up the HOPE assessment

Quality & Reporting

HOPE Submission Window

30-day deadline for submitting each HOPE record to iQIES

Quality & Reporting

Hospice Aide Supervision Requirements

Training, competency, and RN oversight rules for aides

Clinical

Hospice Election Statement Addendum

Written notice listing items the hospice considers unrelated

Clinical

Hospice Enrollment Moratorium

Temporary CMS freeze on new Medicare hospice enrollment

Compliance

Hospice Payment Reform

CMS restructuring of hospice payment toward cost-aligned rates

Reimbursement

Hospice Visits in the Last Days of Life (HVLDL) Measure

Claims-based quality measure of visit intensity near death

Quality & Reporting

HQRP Compliance Threshold

90% submission rate required to receive the full payment update

Quality & Reporting

HVLDL Calculation

Claims-based formula for the last-days-of-life visit measure

Reimbursement

IDG Composition Requirements

Required members and meeting rules for the interdisciplinary group

Clinical

Informal Dispute Resolution (IDR) Process

Process to dispute condition-level survey findings before enforcement

Compliance

Levels of Care Transition Criteria

Clinical conditions determining RHC, CHC, respite, or GIP

Clinical

Live Discharge Rate

Share of hospice discharges where the patient leaves alive

Reimbursement

Medicaid HCBS Waiver Programs

State waivers funding home and community-based long-term care

Home Care

Medicare vs. Medicaid Hospice Benefits

Federal Part A entitlement vs. optional state plan benefit

Billing & RCM

Non-Hospice Spending

Medicare spending outside the per diem during a hospice election

Reimbursement

Notice of Election (NOE)

Electronic notice that opens a hospice benefit period with the MAC

Billing & RCM

Notice of Termination/Revocation (NOTR)

Electronic notice that closes an open benefit period

Billing & RCM

Ownership-Type Peer Group

For-profit, nonprofit, and government comparison cohorts

Compliance

Payer Mix Optimization

Managing the blend of payers on census to protect margin

Billing & RCM

Payment Suspension and UPIC Review

Medicare payment withholding triggered by fraud allegations

Compliance

PEPPER Report

CMS compliance tool comparing billing patterns to national benchmarks

Billing & RCM

Per Diem Blending

Weighted-average daily rate across all levels of care

Reimbursement

Plan of Care Update Triggers

Intervals and events requiring a care plan review

Clinical

Prior Authorization in Home Care

Payer-required service approval before delivery or payment

Billing & RCM

Private Pay vs. Medicaid Home Care

Market-rate direct payment vs. state-funded authorized services

Home Care

Recertification Face-to-Face Requirements

Required in-person visit before the third and subsequent benefit periods

Clinical

Relatedness Determination

Clinical judgment on whether a service is covered under the per diem

Compliance

Remittance Advice Reconciliation

Matching payer remittances against submitted claims

Billing & RCM

Revenue per Patient Day (RPPD)

Total revenue divided by total patient days

Reimbursement

Routine Home Care Rate Tiers

Two-tier RHC per diem: days 1–60 vs. day 61+

Reimbursement

Service Intensity Add-on (SIA)

Supplemental Medicare payment for end-of-life RN and MSW visits

Reimbursement

SFP Graduation Criteria

Standards a hospice must meet to exit the Special Focus Program

Compliance

SIA Eligibility Criteria

Visit and timing conditions that qualify for SIA payment

Reimbursement

Six-Month Prognosis Documentation

Physician certification of terminal life expectancy

Clinical

Special Focus Program (SFP) Eligibility

Algorithm-driven selection of poorest-performing hospices

Compliance

SSVI Peer Comparison Methodology

How CMS scores hospices against national thresholds

Compliance

SSVI Score

Claims-based composite score flagging utilization and spending outliers

Compliance

Star Rating Calculation

How CMS derives the one-to-five-star Care Compare rating

Quality & Reporting

Survey Deficiency Weighting

How CMS classifies and scores hospice survey findings

Compliance

Volunteer Services Compliance

5% volunteer hour requirement and documentation rules

Clinical

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