Eligibility & Verification
Coverage checks before every visit.
Specialty Billing
Home Health Medical Billing
Home health billing follows PDGM episodic rules with strict documentation timing. We manage OASIS-driven billing and NOA/RAP submissions so episodes are billed accurately and on schedule.
The Challenge
Home Health billing, solved
We understand the billing complexities unique to home health and build them into every claim.
- PDGM / episodic billing
- OASIS and documentation timing
- NOA / RAP submission deadlines
What we focus on
- PDGM period billing
- OASIS-aligned coding
- Notice of Admission (NOA)
Coding Focus
Home Health code sets we work in
The CPT/HCPCS procedure families and ICD-10 diagnosis groups our certified coders handle for this specialty every day.
Common CPT / procedure codes
- G0299Skilled registered-nurse visit in the home
- G0151Physical therapy discipline visit at residence
- G0180Physician certification of the home-health plan
- G0156Home health aide service delivery
ICD-10 diagnosis focus
- Wounds and pressure injuries driving skilled care (L89 family)
- Stroke and neurological rehabilitation needs (I60–I69)
- Diabetes with complications requiring monitoring (E08–E13)
- Aftercare and functional-mobility status codes (Z-code family)
Code references are shown as general identifiers for illustration. Actual code selection always follows current payer rules and your provider's documentation.
Clean Claims
Modifiers, denials & billing rules we manage
How our team keeps home health claims compliant — the modifiers that matter, the denials we prevent, and the guidelines we follow.
Key modifiers
- KX
Attests that coverage and medical-necessity requirements for the discipline are fully documented.
- CQ
Flags visits furnished in whole or part by a physical therapist assistant.
- CO
Flags visits furnished in whole or part by an occupational therapy assistant.
- GA
Signals a signed advance beneficiary notice is on file when denial is possible.
Common denials & fixes
Notice of Admission or RAP submitted after the timely-filing window.
Track the admission date and file the NOA within the payer deadline to avoid per-day payment reductions.
OASIS assessment does not support the billed HIPPS or clinical grouping.
Reconcile the OASIS answers with the diagnosis and plan before the claim drops so the period groups correctly.
Missing or invalid face-to-face encounter documentation.
Confirm the certifying provider's encounter note ties the reason for home care to the ordered services.
Overlapping episode with another home-health provider.
Verify eligibility and transfer status up front and coordinate the period start to prevent duplicate billing.
Billing guidelines
- Confirm the 30-day PDGM period start and grouping before releasing any claim.
- Keep OASIS coding, the plan of care, and the primary diagnosis fully aligned.
- Submit the Notice of Admission promptly to protect period payment.
- Document the physician face-to-face encounter and recertification on schedule.
End-to-End
What we handle for Home Health
A complete revenue cycle service tailored to your specialty.
Specialty Coding
Certified, specialty-trained coders.
Charge Entry & Claims
Clean, accurate claim submission.
Payment Posting
ERA/EOB posting and reconciliation.
Denial & AR Management
Appeals and aggressive AR recovery.
Reporting & Analytics
Real-time KPIs and insights.
98%
Clean claim rate
30%
Average revenue lift
24/7
Operations coverage
HIPAA
Compliant processes
FAQ
Home Health billing — FAQs
Yes — our certified coders are trained on specialty-specific rules, code sets, and payer policies, and we assign coders with experience in your specialty.
We work in your current practice management system and EHR, so your workflows and reporting stay intact while we handle the billing.
Through accurate specialty coding, front-end eligibility checks, clean claim submission, and relentless denial and AR follow-up — typically lifting first-pass acceptance and net collections.
Always. We use strict access controls, encryption, signed BAAs, and audit trails to protect patient data.
More Specialties
Other specialties we bill for
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