The Centers for Medicare and Medicaid Services (CMS) has released a significant number of changes and updates in recent months. The Hospice Outcomes and Patient Evaluation (HOPE) assessment is one of the most pertinent for revenue cycle leaders in hospice organizations.
The launch of the HOPE assessment tool is the premiere of a patient assessment method that is meant to standardize data collection for hospice patients. It will have a direct impact on hospice billing services, meaning that revenue cycle leaders who want to stay ahead of changes coming down from CMS will benefit from familiarizing themselves with the origin, differences from previous standards, and implications for healthcare providers. This article will walk you through a foundational understanding of the assessment tool and prepare you for application of deeper response strategies at your organization.
The HOPE Assessment Tool Is a Shift for Hospice Billing Services
The HOPE assessment tool, developed by CMS, marks a pivotal shift in hospice care evaluation, replacing the Hospice Item Set (HIS) as part of the Hospice Quality Reporting Program (HQRP). Finalized in the FY 2025 Hospice Wage Index Final Rule, this tool is designed to standardize data collection while providing a more dynamic understanding of patient needs, care planning, and potential reimbursement refinements. Unlike HIS, which relied on retrospective chart abstraction, the HOPE Hospice Tool captures real-time clinical data through structured assessments, enabling more responsive care adjustments.
The development of the HOPE assessment checklist involved a rigorous, multi-phase process that included stakeholder feedback, cognitive testing, and national beta trials. CMS engaged with hospice providers, clinicians, and technical experts to ensure the tool’s practicality and alignment with real-world workflows. The result is a system that not only meets regulatory requirements but also enhances clinical decision-making.
When fully implemented in October 2025, the HOPE assessment tool is expected to equip providers with actionable insights to refine care strategies, improve patient outcomes, and strengthen operational efficiency.
HOPE vs. HIS: What Hospice Providers Need to Change in 2025
While HIS was limited to verifying care processes through post-discharge chart reviews, the HOPE assessment tool introduces a proactive, multi-point assessment framework. HIS data was collected only at admission and discharge, but HOPE expands the scope with HOPE Update Visits (HUVs) and Symptom Follow-Up Visits (SFVs), offering a more granular view of patient needs over time.
HUVs, conducted between days 6–15 and 16–30 of a patient’s stay, require in-person skilled nursing assessments to update care plans based on evolving conditions. These visits ensure CMS captures critical data during the first 30 days of hospice care, a period often marked by significant symptom fluctuations. Meanwhile, SFVs – triggered by moderate or severe symptom impact – must be completed within two calendar days of the initial assessment. Unlike traditional symptom checks, SFVs focus on the impact of symptoms (e.g., disruptions to sleep or daily activities) rather than their severity alone. This distinction underscores CMS’s emphasis on patient-centered outcomes.
For providers, adapting to these changes requires both operational and technological adjustments. Staff must be trained to complete the HOPE assessment checklist accurately, while EMR systems need updates to support new data fields and submission requirements. The HOPE guidance manual provides detailed instructions, but agencies should begin internal audits now to identify workflow gaps and ensure compliance ahead of the October 2025 deadline.
HOPE has Strategic Implications for Hospice Leadership
The HOPE hospice tool is a catalyst for improving care quality and operational transparency. Two initial quality measures, focused on timely symptom follow-ups, will take effect in FY 2028, with more metrics likely as CMS refines the tool. These measures will eventually factor into public reporting, making adherence a priority for agencies aiming to maintain competitive reputations.
To prepare, hospice leaders should:
- Conduct a workflow analysis to identify how HUVs and SFVs will integrate with existing care and billing processes.
- Collaborate with EMR vendors to ensure systems can generate compliant HOPE records and submission files.
- Invest in staff training using CMS resources, emphasizing the differences between HIS and HOPE documentation.
For hospice billing services, the shift to HOPE introduces both challenges and opportunities. Accurate, timely data submission will be critical to avoid penalties and secure optimal reimbursement. Agencies that leverage the HOPE system effectively will not only meet compliance standards but also gain insights to streamline revenue cycles and reduce claim denials.
Engaging with CMS and Staying Ahead
CMS has committed to ongoing stakeholder engagement, offering forums, webinars, and help desk support to ease the transition. Hospice revenue cycle leaders should actively participate in these opportunities, providing feedback on pain points and advocating for practical refinements.
Leaders should consider regularly monitoring the HQRP website for updates and assigning a team member to oversee HOPE-related communications. This will help ensure agencies remain agile as policies evolve. By embracing the HOPE assessment tool as a strategic asset, rather than a mere compliance obligation, hospice leaders can position their organizations for long-term success in an increasingly data-driven landscape.
Preparing Your Revenue Cycle Strategy for HOPE
To help you successfully navigate this new assessment standard, 3Gen Consulting offers tested expertise in hospice billing services. Our experts support hospice agencies with end-to-end revenue cycle management—keeping you ahead of changes to minimize negative impact and maximize your strategic response. We have documented results, saving a leading home health and hospice company 42% in costs.
Whether you’re helping your internal teams adapt to the HOPE assessment tool or looking for a partner to support hospice billing services, we’re here to help. Contact us today to get started.
