AI for hospice and palliative care providers.
The facility bills what it chooses; netting every line down to the Medicare allowable is your job. Suppliers invoice weekly against a price list nobody re-checks. We encode the rules your billing team carries in their heads — so the checking happens before the money leaves.
Official services partner of the platforms defining AI
NVIDIA
Anthropic
Revenue leaks one underpaid line at a time.
From finance and billing leaders inside a PE-backed, multi-site hospice provider — facility invoices, supplier invoices, and DME rentals, every week.
The facility bills what it wants
The nursing home sends a charge, not the Medicare allowable. Netting every line down to the allowable is your job — the facility has no incentive to do it, and disputes stay rare because nobody has time to raise them.
The allowable is a moving target
The right rate depends on the Medicare year — October through September, not the calendar — the state and county locality, the place of service, and the code on the line. Medicaid-primary patients pay at the state Medicaid allowable instead. Every lookup happens by hand, per line, per patient.
Fifty lines against one roster
Every room-and-board line has to check against the patient roster: was this patient on service these days? A single invoice can run fifty lines, and each one is verified by a person who has other work to do.
Supplier invoices nobody re-checks
The contracted price list updates once a year; the invoices arrive weekly. Case-versus-each unit conversions hide the variance, and with no PO system there is nothing between the invoice and the payment run but someone’s memory.
DME rentals that outlive the stay
The bed, the walker, the oxygen keep billing after discharge — sometimes after a death you already reported. Medicare pays a per diem; every day the rental outlives the stay is a day you pay and don’t get paid.
The workflows worth encoding first.
Each card is a workflow or capability built on the same pattern: your allowables, rosters, and price lists — encoded inside the systems you already run.
They have no incentive whatsoever to reduce their invoice down to the Medicare rate. They send a charge — the onus is on us to figure out the allowable and net it down.
Led by Peter Enestrom.
Asked by hospice operators.
The straight answers, before you book anything.
No. Your team keeps billing and payment — we don’t bill for you. We encode the checking that eats your staff’s week: roster verification, allowable lookups, price-list matching. What the rules resolve happens on its own; what they cannot lands in a review queue for a person.
It is the system of record, not an obstacle. Rosters, service dates, and payer source come out of your EMR; approved amounts post to your payment flow. Nothing gets replaced, your team keeps its screens — and patient identifiers are used to match invoices to rosters inside your environment, never to train anything.
CMS allowables are matched by Medicare year — October through September — state and county locality, place of service, and code, against the date of service parsed from the invoice. Medicaid-primary patients fall to the state Medicaid allowable. Lines with no valid code are not reimbursed — your rule, encoded.
The corrected amount is what gets paid, and the denial carries the reason, so AP has the answer when the facility calls. A facility that disagrees resubmits — outside the flow, the same as your process today.
Two weeks inside your invoice flow, fixed fee: we map the rules, quantify the leak in your own numbers, and hand you a ranked opportunity map. The audit fee credits toward the first build if you continue; the map is yours if you do not.
Start with one workflow.
Tell us where your team loses hours. We will come back with a straight answer on whether AI can help, what it would take, and what it would pay.