Your notes are your payment. Do they say what CMS looks for?
NoteGrade Hospice compares your notes, from aides to physicians, with what CMS has published, and shows you exactly where they could be stronger. You get the feedback. Your team makes every decision.
Free sample: 2–3 randomly chosen staff members, scored and emailed to you. No call required.
Grade F
Illustrative example
The problems you don't see until an auditor does.
"We got an ADR and the notes don't prove decline."
The chart says PPS 40, WNL, unchanged since last visit, for months. Reviewers look for measurable decline, and it isn't written down.
Points out notes that don't yet show decline the way the published LCDs describe it, so your clinicians can document what they actually see at the next visit.
"Our CTIs and face-to-faces are late, copied or both."
Initial certifications signed a week after admission. Recert narratives that read like last period's. A face-to-face dated after the period started. CMS ties payment to each of these.
Compares every CTI, recert and face-to-face with the published requirements in 42 CFR 418.22 (timing, signer, narrative, attestation) and lists the ones that appear to be past due.
"Our long-stay patients worry me at recert."
Dementia patients at FAST 6, no weights, no complications documented. Long stays where the chart doesn't tell the story the clinicians know.
A list, with every review, of patients whose documentation is missing elements the published LCD for their diagnosis describes. Eligibility is always your physician's determination.
"My DON can't read every note."
Hundreds of notes a week. Chart review tends to happen when a survey or an audit letter forces it.
Reviews your notes on the schedule you choose and sends a leadership report with scores and the notes worth a second look. What to do about them is up to you.
"Aides click every box."
Bed bath, chair bath and shower in one visit. Three meals in 55 minutes. A shower marked done that the aide's own note says was refused. Reviewers notice inconsistencies like these.
Points out tasks that conflict with the narrative, overlapping visit times and unanswered pain questions, so your supervisors can look into them.
"Notes sit unsigned for days."
Open visit issues pile up, and CMS expects notes to be authenticated by the person who made the visit.
Lists every unsigned note by staff member on each review, until it's closed.
"We're missing visits on the plan of care."
The order says RN twice a week. The chart shows once, with no missed-visit note and no physician notified.
Compares visits with the ordered frequency for every discipline and shows patients below it before the week ends.
"On-call is a black box."
A 5 AM call, a fall, an ER trip, and the note is a row of checkboxes. No record of what happened or who was notified.
Reviews on-call notes and incident forms and points out where assessments, notifications or follow-up aren't documented.
"Training doesn't stick."
New hires, turnover, and an in-service once a year. Everyone charts the way they always have.
A short refresher for each discipline with a pre-sign checklist, plus real-note scores that show whether it worked.
What a first review found.
CMS's published guidance asks hospice documentation to show the patient's terminal condition and decline. Charts full of "WNL," repeated vitals and conflicting task boxes make that hard to see.
From one hospice's first week with NoteGrade: 61 notes from 20 staff.
From sign-up to your first grades.
Request a sample
Send us your agency details, then accept the Business Associate Agreement and sample terms online. No meetings, no contracts to negotiate.
Give us read-only access
Create a dedicated read-only user in your EMR. We never edit, sign or delete anything.
Get your free sample
We grade 2–3 randomly chosen staff on their recent notes and email you their scores, findings and patient risks.
Pay and start
Your sample comes with a recommended plan. Pay online and your first review starts right away. Most agencies start daily for two weeks, then step down to weekly or 3 times a week as scores improve. Every review grades recent notes, sends a leadership report, and updates running scores for every staff member and patient.
A regular read on your documentation.
Staff scorecards
A 1–100 grade for every clinician and aide, what's working, and specific examples of what to fix, with the trend over time.
Physician & NP certifications Add-on
Every CTI, recertification and face-to-face compared with 42 CFR 418.22 for timing, signer and narrative, plus a list of items that appear past due.
Patient documentation gaps
Which patients' charts are missing elements the published LCDs describe, and what those elements are. Eligibility stays your physician's call.
Visit frequency vs. plan of care
Patients below their ordered visit frequency for each discipline, and whether missed visits were documented.
Red flags
Escalations not documented, incomplete incident forms, tasks that conflict with the narrative, overlapping visit times, unsigned notes.
Fix-it questions
Open-ended clarification questions for each flagged note, so staff can add accurate late entries without being led.
Charting refresher
A short course for each discipline, with a pre-sign checklist and quiz, and completion tracking for your DON.
Here's what lands in your inbox.
Three example reports, exactly as they arrive by email: your free sample results, your ongoing leadership report with a grade for every staff member, and the physician & NP review. All examples use a fictional agency and fictional staff.
- The headline numbers. Your sample average, how scores changed from week 1 to week 4, and how many notes were unsigned after 24 hours.
- Our recommendation, and why. Which plan fits your agency, tied to specific findings, with the estimated monthly cost.
- Trends for each person. Every sampled staff member's score week by week, so you can see who's improving.
- What we found. Specific examples from their notes, with a clearer way to write them, and patient documentation gaps by initials.
Feedback on the notes most programs never review.
The certification of terminal illness, the recert narrative and the face-to-face are central to what CMS publishes about hospice eligibility documentation. We compare each one with the published requirements and share what we see. Your physicians make every clinical determination.
Grade F
Fictional example, not a real provider
What we compare
- Who wrote the narrative. CMS asks the certifying physician to compose it. We point out narratives that closely match nursing notes, the face-to-face or last period's text, and show the overlap.
- Timing. Initial certification, recert window and the 30-day face-to-face window, as published in 42 CFR 418.22.
- Face-to-face elements. Practitioner name, encounter date, findings, and the attestation that findings were provided to the certifying physician.
- Consistency. FAST, PPS, age and diagnosis that differ between the physician, NP and nursing notes.
- Open items. Certifications and face-to-faces that appear past due on your EMR's list.
Feedback for each provider
A 1–100 score for each physician and NP, with the specific notes behind it.
An open-items list
Certifications and face-to-faces that appear past due, for your team to verify.
Examples, not orders
Sample narrative structure and the attestation wording CMS describes, for your providers to adapt in their own words.
One rubric for every discipline, based on what CMS has published.
Based on the hospice Conditions of Participation (42 CFR Part 418), the certification rules in 42 CFR 418.22, and the hospice LCDs for each terminal diagnosis.
| RN, social work, chaplain | Points |
|---|---|
| Signed and complete within 24 hours | 10 |
| Complete assessment | 15 |
| Measurable decline compared with prior visits | 20 |
| Supports the terminal prognosis (LCD) | 15 |
| Individualized narrative, not cloned | 15 |
| Accurate and internally consistent | 15 |
| Escalation and coordination | 10 |
| Hospice aide | Points |
|---|---|
| Signed and complete | 15 |
| Tasks charted match what was done | 25 |
| Observations of the patient | 25 |
| Pain and bowel answered; changes reported | 20 |
| Real visit times | 15 |
| Physician & NP: certification of terminal illness | Points |
|---|---|
| On time: initial within 2 days of care, recert no earlier than 15 days before the period | 15 |
| Right signers and attestation (only physicians certify) | 15 |
| Physician's own narrative, specific to the patient, not copied | 25 |
| Clinical findings support the prognosis and the LCD | 20 |
| Face-to-face findings used (3rd benefit period and later) | 10 |
| Consistent with nursing documentation and the IDG | 10 |
| Signatures and dates complete | 5 |
Face-to-face encounters are graded separately for timing (within 30 days before the period), exam findings, and the NP's attestation to the certifying physician.
What's new from CMS for hospice.
We check official CMS and Federal Register sources every day and post short, plain-language summaries of hospice-related changes with a link to the source. Summaries are informational; the official text controls.
The weekly hospice brief: 3 stories, 3 minutes.
Every week, up to three stories: new CMS rules and the hospice news that matters, in plain language with links to the source. Unsubscribe anytime.
Free to start. Start strong, then step down as your notes improve.
- 2–3 randomly chosen staff
- Recent notes graded 1–100
- Findings and patient documentation gaps
- A recommended plan: which pace fits your agency, and why
- Results emailed to you, with week-by-week trends
Per active patient / month
Our suggestion: start on Daily for two weeks while your staff adjust, then step down to Standard or Plus once scores improve.
- Setup: EMR connection, staff roster, visit frequencies and your baseline audit
- Staff and patient scores with trends
- Visit frequency compliance
- Leadership report after every review
- Charting refresher for all staff
- Change plans anytime
- Starts the moment you pay: no sales call, no waiting
Physician & NP Certification Review
- Every CTI, recertification and face-to-face graded
- Timing, correct signer and attestation checks
- Narratives that closely match other notes pointed out
- List of items that appear past due
- Scores for each physician and NP
Add it to any plan at any time. Reviewed monthly.
Refer an agency. Earn $200 up front and 10% for as long as they're a client.
Know a hospice owner or administrator who'd want this? Send them your link. When they become a paying client, you earn 20% of their one-time setup fee, plus 10% of what they pay us every month for as long as they stay.
Get your link
Sign up as an associate and get a personal link and code.
They sign up
The agency signs up with your link or code. Their free sample counts.
You earn 20% + 10%, for life
20% of the setup fee when they start, then 10% of every monthly payment for as long as they remain a client.
Program terms
- 20% of the one-time setup fee and 10% of monthly fees we actually collect from the referred agency, for the life of the account, paid monthly.
- The agency must be new to NoteGrade and sign up with your link or code within 90 days of your referral.
- You can't be an owner, employee or contractor of the agency you refer, and you can't refer your own agency.
- Referral fees are paid only for introducing agencies to our consulting service, never for referring patients or any Medicare-billed service.
- A W-9 is required before payout. Program terms are in the written referral partner agreement.
Before you sign up.
Will NoteGrade change anything in our charts?
No. We use a read-only user you create, and we never edit, sign or delete anything. Corrections stay with your staff, as dated late entries.
How do you protect patient information?
We sign a Business Associate Agreement before we see any patient data, access only what grading requires, and identify patients by initials in reports.
Which EMRs do you work with?
Footprints today. Ask at sign-up about others; each EMR needs a short setup before we can grade it.
Who sees the scores?
Your leadership team. Staff see their own results only if you choose to share them.
Do you tell our staff or physicians what to do?
No. We share feedback on how documentation compares with published CMS regulations and guidance, and examples of how a note could be clearer. Clinical judgment, eligibility, care decisions and any corrections belong to your clinicians, physicians and leadership.
Is this legal, billing or medical advice?
No. NoteGrade is educational documentation consulting. It isn't legal, billing, coding or medical advice, and it doesn't determine eligibility or whether a claim will be paid. For those questions, talk to your compliance counsel.
Do you guarantee audit results?
No. Better documentation can help your notes reflect the care you give, but no consultant can guarantee the outcome of an ADR, TPE, survey or other review.
Does this replace our compliance program?
No. It's an ongoing quality check that gives your clinical and compliance team a place to start.
What happens after the free sample?
Nothing, unless you choose a plan. Your sample results include a recommended plan based on what we found. If you go ahead, there's a one-time setup fee, then monthly billing by your active census. You can change plans as your scores improve.
Request your free sample.
Tap the button and send us your agency details. Then:
- We send your sample agreement, including our Business Associate Agreement, to accept online.
- You create a read-only user in your EMR. We never edit, sign or delete anything.
- We pull and grade recent notes from 2–3 randomly chosen staff.
- You get scores, trends and a recommended plan by email. Like what you see? Start right away.