Home Health & Hospice Software: Combined Solutions, Requirements & Selection Guide
Agencies offering both home health and hospice services face a critical technology decision: combine everything into one platform or use specialized systems for each service line. This interactive guide walks you through the assessment, feature requirements, regulatory differences, and transition planning you need to make the right choice in 2026.
Home Health vs. Hospice: Understanding the Differences
Before evaluating home health and hospice software, it is essential to understand how these two service models differ in purpose, structure, and regulatory requirements.
Home Health
Home health provides skilled clinical services (nursing, physical therapy, occupational therapy, speech therapy, medical social work) to patients recovering from illness, injury, or surgery. The goal is restorative — helping patients regain independence and function.
Hospice
Hospice provides comprehensive comfort care and support to patients with a terminal illness (prognosis of 6 months or less). The goal is palliative — managing symptoms, reducing suffering, and supporting the patient and family through end of life.
Key Distinction for Software Selection
While both services are delivered in the home, their documentation, billing, and compliance requirements are fundamentally different. Home health software must handle OASIS assessments and PDGM case-mix billing, while hospice software must manage IDG care plans, per diem billing across four levels of care, bereavement tracking, and volunteer hour monitoring. A combined platform must handle both sets of requirements without compromise.
Combined vs. Separate Software Assessment
Answer 10 questions about your agency to receive a data-driven recommendation on whether a combined or separate software approach is right for you.
How large is your agency (total active patients across all service lines)?
Larger agencies often benefit from unified platforms to avoid data silos.
What is your approximate home health to hospice patient ratio?
Heavily skewed ratios may favor a specialist system for the dominant service.
How many payer types does your agency bill?
More payer types increases the value of a unified billing engine.
What percentage of your clinical staff works across both home health and hospice?
High staff overlap strongly favors a combined platform for unified scheduling.
Do you need unified reporting across both service lines?
Cross-service analytics require shared data, favoring combined systems.
What IT resources does your agency have for managing software?
Multiple systems require more integration work and IT oversight.
How many separate software systems does your agency currently use?
Agencies already managing multiple systems may have integration expertise.
Which budget concern is most important to your agency?
Combined platforms generally have lower total cost of ownership.
What are your growth plans for the next 2 - 3 years?
Rapid expansion across service lines favors flexible combined platforms.
How often do patients transition between your home health and hospice services?
Frequent transitions require seamless patient record sharing.
Feature Requirements Matrix
Explore 40+ home health software features grouped by category. Filter by service type to see which features are required, optional, or not applicable for home health, hospice, or combined agencies.
| Feature | Home Health | Hospice | Combined |
|---|---|---|---|
OASIS Assessment Integration OASIS-E2 data collection at all CMS-required time points for home health episodes. | |||
HOPE Assessment Tool Hospice Outcomes and Patient Evaluation tool, replacing HIS as of October 2025. | |||
Plan of Care (485) Management Physician-signed plan of care with specific discipline orders and visit frequencies. | |||
IDG Care Plan & Meeting Notes Interdisciplinary Group care plan review and documentation at required intervals. | |||
Clinical Visit Documentation Point-of-care charting for skilled nursing, therapy, aide, and social work visits. | |||
Medication Management Medication reconciliation, profiles, and administration documentation. | |||
Physician Order Management Order tracking, verbal order management, and physician signature capture. | |||
Wound Care Documentation Specialized wound assessment tools, staging, measurements, and photo documentation. |
OASIS Assessment Integration
OASIS-E2 data collection at all CMS-required time points for home health episodes.
HOPE Assessment Tool
Hospice Outcomes and Patient Evaluation tool, replacing HIS as of October 2025.
Plan of Care (485) Management
Physician-signed plan of care with specific discipline orders and visit frequencies.
IDG Care Plan & Meeting Notes
Interdisciplinary Group care plan review and documentation at required intervals.
Clinical Visit Documentation
Point-of-care charting for skilled nursing, therapy, aide, and social work visits.
Medication Management
Medication reconciliation, profiles, and administration documentation.
Physician Order Management
Order tracking, verbal order management, and physician signature capture.
Wound Care Documentation
Specialized wound assessment tools, staging, measurements, and photo documentation.
Hospice vs. Home Health Regulatory Comparison
Click each category to explore the side-by-side regulatory requirements. Understanding these differences is critical for home health and hospice software evaluation and compliance planning.
Must designate an administrator responsible for day-to-day operations and ensure all services are provided per regulations.
Must have an identifiable governing body with full legal authority for operations. Medical director must be a licensed physician.
Must inform patients of rights, provide written notice of care, and respect patient autonomy in care decisions.
Must provide written information about rights including right to elect/revoke hospice, choose attending physician, and voice grievances.
Requires a comprehensive patient assessment (OASIS) within 5 days of start of care by a qualified clinician.
Requires comprehensive assessment within 5 days of election. Updated per IDG review schedule. Includes physical, psychosocial, emotional, and spiritual needs.
Plan of care (Form 485) signed by physician, reviewed every 60 days. Must include disciplines, frequency, and goals.
IDG develops and maintains individualized care plan reviewed every 15 days. Must address all identified patient and family needs.
Must maintain QAPI program using data-driven approach, including outcome measures and patient safety indicators.
Must maintain QAPI program that reflects the complexity of the organization. Must track and analyze quality indicators and take corrective action.
Must maintain infection prevention and control program. Standard precautions, hand hygiene, PPE protocols required.
Must maintain infection control program with surveillance, prevention, and reporting components.
Medicare Billing Differences: PDGM vs. Per Diem
One of the most significant home health software distinctions. Home health and hospice use fundamentally different Medicare payment models, and your home health and hospice software must support both.
Home Health: PDGM
Patient-Driven Groupings Model
Payment Structure
Payment per 30-day period based on classification into 432 case-mix groups determined by admission source, timing, clinical grouping, functional impairment, and comorbidity adjustment.
CY 2026 Update
- Permanent prospective adjustment of -1.023%
- Aggregate payments estimated to decrease 1.3% ($220M)
Key Billing Elements
- Notice of Admission (NOA) replaces RAP
- OASIS assessment drives case-mix weight
- LUPA thresholds for low-utilization periods
- No cap on number of 30-day periods
- UB-04 (837I) institutional claims
Software Must Support
- Automatic PDGM case-mix group calculation
- 30-day period tracking and sequencing
- LUPA monitoring with visit count alerts
- NOA submission workflow
Hospice: Per Diem
Four Levels of Care Payment
Payment Structure
Daily per diem payment based on the level of care provided each day. Four prospectively determined rate categories cover all costs related to the terminal illness.
FY 2026 Update
- Payment rate increase of 2.6% ($750M increase)
- Cap amount: $35,361.44 per beneficiary
Four Levels of Care
Standard daily rate for days when patient receives home-based hospice care. Most common level.
Hourly rate for periods of crisis. Requires minimum 8 hours of predominantly nursing care in a 24-hour period.
Short-term inpatient stays (max 5 consecutive days) to relieve primary caregiver.
Inpatient care for pain/symptom management that cannot be managed in other settings.
Software Must Support
- Per diem claims for all four levels of care
- NOE filing within 5 calendar days
- Aggregate and per-beneficiary cap tracking
- Benefit period and certification management
Why This Matters for Software Selection
The billing engines for home health (PDGM/episode-based) and hospice (per diem/daily) are architecturally different. A combined platform must maintain two complete billing systems under one interface, while separate systems each only need to handle one. When evaluating combined platforms, test the billing workflow for both service lines thoroughly — a platform that excels at home health PDGM billing may have a bolted-on hospice module that creates workflow friction, and vice versa.
Adding a Service Line: Transition Planning Tool
Planning to add hospice to your home health agency (or vice versa)? Use this interactive checklist to track your progress across 27 key steps in 6 categories.
Overall Transition Progress
0%0 of 27 steps completed
Quality Reporting Requirements: HHQRP and HQRP
Both home health and hospice agencies must participate in CMS quality reporting programs. Your home health software must support data collection, submission, and performance monitoring for the applicable program.
HHQRP
Home Health Quality Reporting Program
Assessment Tool
OASIS-E2 (Outcome and Assessment Information Set) submitted via iQIES. Required at start of care, resumption of care, recertification, transfer, and discharge.
Quality Measures
- OASIS-based outcome measures (functional improvement, hospitalization rates)
- Claims-based measures (emergency dept. use, hospitalization)
- HHCAHPS patient experience survey
HHVBP Expanded Model
Home health agencies also participate in the Home Health Value-Based Purchasing (HHVBP) Expanded Model, which applies payment adjustments (up to +/-5%) based on quality performance relative to peers.
CY 2026 Update
Removal of the COVID-19 vaccination measure and corresponding OASIS data item (O0350) effective April 1, 2026.
HQRP
Hospice Quality Reporting Program
Assessment Tool
HOPE (Hospice Outcomes and Patient Evaluation) tool, effective October 2025, replacing the Hospice Item Set (HIS). Submitted via iQIES.
Quality Measures
- HOPE-based measures (symptom management, care processes)
- Claims-based measures (visits in last days of life)
- Hospice CAHPS experience survey
Non-Compliance Penalty
Hospice agencies that fail to meet HQRP requirements face a 4% reduction in their Annual Payment Update (APU). This is a pay-for-reporting program — timely submission is what matters.
FY 2026 Update
CMS finalized updates to the HQRP in the FY 2026 Hospice Final Rule, including continued transition to HOPE-based data collection and reporting.
Software Implication
Your software must integrate with iQIES for both OASIS (home health) and HOPE (hospice) data submission. If using a combined platform, verify that it supports both assessment tools and has updated to the HOPE tool that went live October 2025. Some vendors were slow to adopt HOPE, creating compliance risk. Also ensure quality measure dashboards track the right program for each service line.
Staff Training Considerations for Cross-Service Agencies
Managing both home health and hospice requires staff who understand the philosophical, clinical, and regulatory differences between the two. The best home health software simplifies training with built-in guidance, but staff must still cover these distinct domains.
Philosophy of Care
- Curative (home health) vs. comfort-focused (hospice) mindset
- Managing patient/family expectations at transition
- Ethical considerations in end-of-life care
- Supporting staff emotionally in hospice settings
Clinical Documentation
- OASIS assessment accuracy and timing (home health)
- HOPE tool data collection and submission (hospice)
- IDG care plan documentation requirements (hospice)
- Homebound status documentation (home health)
Billing & Coding
- PDGM case-mix groups and LUPA thresholds
- Per diem billing across four levels of care
- NOE vs. NOA filing requirements and timelines
- Hospice cap monitoring and reporting
Regulatory Compliance
- Home health vs. hospice Conditions of Participation
- Face-to-face encounter requirements per service type
- Terminal illness certification process (hospice)
- Quality reporting obligations for each program
Software Proficiency
- Home health workflow in your platform (OASIS, billing)
- Hospice workflow in your platform (HOPE, per diem billing)
- Switching between service-line modules
- Running quality and compliance reports for each line
Cross-Service Skills
- Identifying patients who may benefit from transitioning
- Facilitating smooth patient handoffs between teams
- Communicating with patients about hospice eligibility
- Coordinating shared staff across both service lines
Frequently Asked Questions
Sources & References
The regulatory information, payment rates, and quality reporting requirements in this guide are sourced from official CMS publications and federal register documents. We recommend checking CMS.gov for the most current information.
- 1CMS CY 2026 Home Health PPS Final Rule (CMS-1828-F)
- 2CMS FY 2026 Hospice Wage Index and Payment Rate Update Final Rule (CMS-1835-F)
- 3CMS Hospice Quality Reporting Program
- 4CMS Hospice Center — Conditions of Participation
- 5CMS Home Health Coding and Billing Information
- 6HQRP Requirements and Best Practices
- 7CMS CY 2025 Home Health PPS Final Rule Fact Sheet (CMS-1803-F)
- 842 CFR Part 418 — Hospice Payment for Hospice Care
- 9MedPAC: Hospice Services Payment System (2024)
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