As more patients shift from inpatient care to home-based care, home health services have become a vital part of the healthcare system. From skilled nursing to physical therapy, occupational therapy, and home health aide services, providers help patients recover in the comfort of their own homes.
However, billing for home health care is highly regulated — especially by Medicare. It involves strict compliance with OASIS documentation, PDGM (Patient-Driven Grouping Model), 60-day billing cycles, and electronic visit verification (EVV). Without expert billing practices, agencies face denials, delayed payments, and compliance risks.
At Progressive RCM, we offer specialized home health billing services that improve cash flow, reduce errors, and keep your agency compliant.
Home Health Billing Challenges
1. Medicare’s PDGM Model
Under the Patient-Driven Groupings Model (PDGM), reimbursement is calculated based on patient characteristics rather than therapy volume. Billing errors under PDGM can cause significant revenue loss or audit exposure.
Key PDGM elements include:
-
Primary diagnosis (ICD-10 codes)
-
Functional impairment level
-
Referral source (community vs. institutional)
-
Admission timing (early vs. late)
2. OASIS Documentation Requirements
Each claim must be supported by timely, accurate OASIS assessments, which determine the patient’s clinical grouping and reimbursement level.
3. 60-Day Billing Cycles
Medicare home health episodes are billed in 30-day periods under PDGM. Agencies must submit timely NOAs (Notice of Admission) and ensure each cycle has valid documentation and services.
4. Electronic Visit Verification (EVV)
Some states require EVV tracking to validate that a visit took place. Lack of EVV data can trigger claim denials or Medicaid penalties.
5. Multiple Payers and Coverage Rules
Billing varies by:
-
Medicare Part A & B
-
Medicaid (state-specific policies)
-
Commercial insurance
-
Private pay
Each requires different authorizations, forms, codes, and billing portals.
Common Home Health Services & Billing Codes
✅ Covered Services:
-
Skilled nursing
-
Physical therapy (PT)
-
Occupational therapy (OT)
-
Speech-language pathology (SLP)
-
Home health aide services
-
Medical social work
-
IV therapy
-
Chronic condition management
-
Wound care and post-operative care
✅ Revenue Codes:
-
042X – Physical therapy
-
043X – Occupational therapy
-
044X – Speech therapy
-
055X – Skilled nursing
-
056X – Home health aide
-
057X – Medical social services
-
058X – Home health visit charge
✅ Common HCPCS Codes:
-
G0151 – PT services in home health setting
-
G0152 – OT services
-
G0153 – SLP services
-
G0154 – Skilled nursing
-
G0156 – Home health aide services
-
G0162 – Skilled services by a registered nurse (RN) for management and evaluation
-
Q5001–Q5009 – Place of service codes for home health
✅ ICD-10 Codes (Examples):
-
I50.9 – Heart failure
-
E11.9 – Diabetes
-
Z48.01 – Surgical aftercare
-
M62.81 – Muscle weakness
-
Z74.09 – Need for assistance with ADLs
Our Home Health Billing Services
At Progressive RCM, we provide end-to-end billing support for home health agencies, ensuring timely submission, proper coding, and compliance with CMS and private payers.
✅ Patient Eligibility & Authorization
-
Verify Medicare and Medicaid eligibility
-
Check coverage and benefits for private insurers
-
Obtain prior authorizations for therapy and specialty services
✅ OASIS Review & Compliance
-
Ensure OASIS assessments are completed accurately
-
Validate clinical documentation supports billing codes
-
Confirm timely submission of NOAs and Claims
✅ Accurate Coding and Grouping
-
Assign accurate ICD-10, HCPCS, and Revenue Codes
-
Ensure diagnosis grouping aligns with PDGM
-
Apply proper modifiers and time-based codes
✅ Timely Claims Submission
-
File NOA (Notice of Admission) within required window
-
Submit 30-day claims under PDGM model
-
Scrub claims for errors before submission
✅ Denial Management & Appeals
-
Identify and correct claim denials (late NOA, invalid OASIS, incorrect revenue code)
-
File timely appeals with supporting documentation
-
Follow up with payers until resolved
✅ EVV Integration & Compliance
-
Integrate with EVV systems to validate visits
-
Ensure documentation and visit logs match claim submissions
✅ Payment Posting & AR Follow-Up
-
Post ERA and EOB payments
-
Reconcile discrepancies
-
Follow up on unpaid or underpaid claims
✅ Detailed Reporting
-
PDGM reimbursement analysis
-
Denial trends by reason and payer
-
Aging A/R reports
-
Visit utilization and missed revenue insights
Why Choose Progressive RCM for Home Health Billing?
✅ PDGM Experts
Our team is trained in the latest CMS home health billing rules, including OASIS-E, NOA processes, and 30-day claim cycles.
✅ Custom Workflow for Home Health Agencies
We adapt to your EMR/EHR system (Kinnser, Axxess, MatrixCare, etc.) and your agency’s operational flow.
✅ EVV-Ready Processes
We help you meet federal and state EVV requirements, minimizing compliance issues and claim denials.
✅ Medicare, Medicaid, & Private Insurance Billing
From Part A claims to Medicaid Waiver programs and private insurance portals — we handle them all.
✅ Reduced Denials, Faster Reimbursements
We reduce NOA delays, coding issues, and documentation gaps, ensuring faster payments and improved cash flow.
Key Metrics We Monitor
-
NOA timeliness rate
-
Days in A/R
-
Denial rate by payer and reason
-
Average reimbursement per 30-day period
-
Missed visit billing opportunities
-
Clean claim submission rate
-
Payer mix performance
SEO Keywords Used:
-
home health billing services
-
PDGM billing solutions
-
home care revenue cycle management
-
Medicare home health coding
-
OASIS-E compliance
-
30-day home health claim submission
-
NOA billing home health
-
EVV integration for home health
-
ICD-10 codes for home care
-
skilled nursing billing
Final Thoughts
Home health billing is one of the most regulated and time-sensitive areas of healthcare revenue cycle management. From PDGM complexity to EVV mandates and payer-specific rules, even small mistakes can cost your agency thousands.
At Progressive RCM, we specialize in home health billing — helping agencies stay compliant, get paid faster, and scale their services confidently.