Denied claims, PDGM coding errors, and late NOA filings are draining your agency’s revenue. Our home health billing specialists fix that. We submit cleaner claims, resolve denials faster, and keep your Medicare and Medicaid reimbursements on schedule.
Home health billing sits at the intersection of clinical documentation, strict Medicare compliance, and an ever-changing payer landscape. One OASIS inaccuracy, a missed Notice of Admission deadline, or a misapplied PDGM grouper can cost your agency thousands in delayed or denied reimbursements.
We’ve spent over a decade working in home health billing. Our team understands the nuances of PDGM payment periods, therapy threshold documentation, face-to-face encounter requirements, and the claims adjudication logic Medicare contractors apply.
That depth of knowledge is what separates us from generalist billing companies and what keeps our clients’ revenue cycles running without interruption.
We audit every claim before submission. We check diagnosis codes, OASIS alignment, and payer-specific requirements, so denials are caught at the source and not discovered weeks later.
Our team tracks every submitted claim through the payer’s review cycle. Anything that stalls gets followed up on immediately. This cuts the time between service delivery and payment into your bank account.
The Patient-driven Groupings Model rewards precision. Our certified coders assign episode groupings, comorbidity adjustments, and functional scores accurately. We ensure your agency captures the full reimbursement it’s entitled to under each 30-day payment period.
Late or missing Notices of Admission result in direct payment reductions. We manage NOA submissions within required windows and maintain documentation standards that hold up to Medicare audit scrutiny.
Your nurses and therapists should focus on patients, not chasing claim statuses. We absorb the entire billing workflow, from verification, coding, submission, and follow-up to payment posting, so your staff can stay in the field.
Every month, you receive a clear breakdown of claims submitted, payments collected, denial rates, and recovery actions taken. No mystery around where your revenue stands.
Before any service starts, we confirm Medicare or Medicaid eligibility, verify prior authorizations, and flag coverage gaps that could lead to non-payment later. Problems caught before service are far cheaper than claims denied after.
OASIS accuracy directly determines your PDGM grouper outcome and your reimbursement level. Our coders cross-reference clinical documentation against OASIS responses to ensure every assessment is coded in a way that reflects the patient’s true conditions and your agency’s legitimate value.
Claims are submitted electronically following CMS and payer-specific formatting requirements. We monitor every claim from submission through adjudication and identify holds or requests for additional information before they become denials.
When a claim is denied, our team responds within 24 hours. We analyze the denial reason, correct the root cause, and submit a compliant appeal with supporting documentation. We track appeal outcomes and identify denial patterns to prevent recurrence.
Every payment received is posted accurately against the corresponding claim, and remittance advice is reviewed to identify underpayments, contractual adjustments, and any discrepancies that require follow-up with the payer.
Medicare’s home health billing regulations change regularly. We monitor CMS updates, transmittals, and payer bulletins, and apply those changes to your billing process immediately. This keeps your agency compliant without requiring your team to track regulatory shifts.
We start every episode with a thorough eligibility check and documentation review. We confirm Medicare or Medicaid coverage, verify physician orders and face-to-face documentation, and identify any gaps before a single service is billed. Clean documentation going in means fewer problems coming out.
Our PDGM-trained coders review OASIS data, assign the correct HIPPS codes, apply appropriate comorbidity adjustments, and submit claims that comply with CMS requirements and payer-specific rules. Every claim leaves our system built to pass, not built to be corrected later.
We monitor every claim through adjudication, follow up aggressively on outstanding reimbursements, manage denials and appeals, and post all payments accurately. At month-end, you receive a complete picture of your revenue cycle performance with no surprises.
Most agencies see measurable improvements within the first billing cycle. Our intake process includes a comprehensive review of your current claims, coding practices, and denial history, which allows us to identify and address the highest-impact issues immediately. Many clients report faster payments and lower denial rates within 30 to 60 days of onboarding.
Yes. Our billing team is trained on the Patient-driven Groupings Model, OASIS-E documentation, and the HIPPS code assignment process. We understand how clinical assessments translate into grouper outcomes, and we work with your clinical staff to ensure that documentation supports accurate and maximized coding.
We apply a multi-point pre-submission review to every claim. Eligibility is verified, diagnosis codes are checked against OASIS data, physician orders and face-to-face documentation are confirmed, and payer-specific rules are applied before submission. Our denial prevention is built into the preparation process, not bolted on after rejection.
Yes. We work with all major home health EHR and billing platforms and can adapt to your existing workflows. Our goal is to absorb the billing burden without disrupting your clinical operations. Onboarding is structured to minimize transition friction and maintain continuity of billing during the handover.
We respond to every denial within 24 hours. Our team analyzes the denial reason, corrects the root cause (whether that’s a documentation issue, coding error, or eligibility problem), and submits a compliant appeal with supporting clinical evidence. We also track denial patterns across your claims to address systemic issues before they affect future submissions.
Absolutely. All billing operations are conducted under strict HIPAA-compliant protocols. Patient data is transmitted and stored using encrypted, secure systems, and access is limited to authorized billing personnel only. We treat the protection of your patients’ information with the same seriousness we apply to protecting your revenue.
Every month you operate with preventable denials, missed NOA deadlines, or miscoded PDGM episodes is a month your agency leaves money uncollected. Our team is ready to audit your current billing, identify the gaps, and build a claims process that actually protects your revenue.