Make Every Hospice Recertification Defensible, Documented, and Compliant
Hospice recertification denials can cost a 500-patient agency $500K–$1.5M a year. Our AI agent reviews every benefit period transition to recommend recertify vs. discharge—with audit-ready documentation.
Key Metrics
The Challenge
Medicare requires hospice physicians to recertify terminal illness at each benefit period (90 days, 180 days, and every 60 days after). Missing Face-to-Face (F2F) encounters, thin decline documentation, and eligibility drift expose hospice agencies to audit denials, recoupments, and compliance penalties.
Pain Points We Eliminate
- Audit denials on long-stay patients and $10,000+ recoupments per denied claim
- Missed or non-compliant Face-to-Face (F2F) encounters
- Insufficient clinical decline evidence in the Certificate of Terminal Illness (CTI)
- Eligibility drift: stabilized patients who continue on hospice service
How We Solve It
Our AI agent analyzes each patient at hospice benefit period transitions—clinical decline, functional status, length of stay, and documentation—to recommend recertify vs. discharge with 99.8% accuracy, flag audit risks, and generate defensible supporting documentation.
Recertify vs. Discharge Decisions
Clear benefit-period recommendations with confidence scores
Audit-Ready Documentation
Generates decline evidence and rationale to support the Certificate of Terminal Illness (CTI)
F2F & Compliance Tracking
Flags Face-to-Face gaps and Medicare eligibility risks before they become denials
Benefit Period Timing
Alerts at Day 90, 180, and 240+ transitions so nothing slips through
How It Works
Confident decisions in four simple steps
Benefit Period Review
Submit patient data as a hospice benefit period transition approaches
AI Analysis
The agent evaluates clinical decline, length of stay, F2F status, and documentation
Recommendation
Receive a recertify/discharge decision with audit-ready supporting documentation
Clinical Action
Care and compliance teams act with confidence and defensible records
Use Cases
Confident decisions across your care management workflow
Benefit Period Recertification
AI-guided recertify vs. discharge decisions at Day 90, 180, and 240+ transitions
Audit & Denial Prevention
Surface documentation gaps and F2F risks before ADRs and Medicare audits
Eligibility Drift Detection
Identify stabilized patients who may no longer meet hospice eligibility criteria
Frequently Asked Questions
Hospice Recertification Intelligence AI — what care teams ask most
Is there an AI agent for recertification in hospice?
Yes. Care Intelligence Engine’s Hospice Recertification Intelligence is an AI agent that analyzes each patient at hospice benefit period transitions and recommends recertify vs. discharge with 99.8% accuracy, along with audit-ready documentation.
What is Hospice Recertification Intelligence AI?
It is an AI model built specifically for hospice agencies that evaluates clinical decline, length of stay, Face-to-Face encounter status, and documentation at each benefit period (90, 180, and every 60 days after) to recommend whether to recertify or discharge a patient and to generate defensible supporting documentation.
How does the hospice recertification AI prevent audit denials?
It flags Face-to-Face (F2F) gaps and eligibility drift before they become denials, strengthens the Certificate of Terminal Illness (CTI) with decline evidence, and produces audit-ready records — helping avoid the $10,000+ recoupments hospices face per denied claim.
How accurate is the hospice recertification recommendation?
The model achieves 99.8% decision accuracy validated against expert clinical review, reduces inappropriate recertifications by roughly 40%, and keeps 100% of recommendations aligned with Medicare hospice coverage criteria.
When should hospice recertification review be run?
Run it as each hospice benefit period transition approaches — Day 90, Day 180, and every 60 days thereafter — to confirm continued eligibility and catch documentation or F2F gaps early.
Ready for Confident Certification Decisions?
See how Recertification Intelligence can help your organization make compliant, optimal decisions every time.