Home Health Billing Services by Prospect Healthcare Solutions
Home Health billing services cover the claims, denials and payments for home health agencies under PDGM and other payers. Prospect Healthcare Solutions handles Notices of Admission, certifications, visit billing and follow-up, so your clinicians can focus on patients at home.
We support home health agencies across the United States from our office in North Smithfield, Rhode Island. If late notices or held claims are slowing your cash flow, start with a free review of your billing.
Prefer to talk? Call +1 (469) 935-4617.
Why Home Health Billing Needs Special Expertise
Home health agencies are paid on periods of care, not single visits. Medicare payment under PDGM depends on OASIS answers, diagnosis grouping and visit counts. Certification, face-to-face and notice rules all have deadlines, so a missing document can hold or reduce a full period of payment.
Home Health Payer Rules We Manage
These are the home health-specific rules our revenue cycle management team checks on every claim. Rules vary by payer and change often, so we confirm each one against current payer policy.
PDGM 30-day periods
What it means: Medicare pays in 30-day periods grouped by clinical and functional factors.
How we handle it: We review groupings and diagnoses before billing.
Notice of Admission
What it means: The NOA generally must be submitted within 5 calendar days of the start of care, or payment can be reduced.
How we handle it: We track deadlines for each admission.
OASIS alignment
What it means: OASIS must be complete and match the claim.
How we handle it: We check OASIS status and HIPPS details before billing.
Face-to-face and certification
What it means: A qualifying encounter and physician certification are required for Medicare home health.
How we handle it: We check signed orders and timing before final billing.
LUPA visit thresholds
What it means: Periods with few visits may be paid per visit.
How we handle it: We review visits before the claim drops.
Medicare Advantage and Medicaid
What it means: These plans can use their own authorizations and visit rules.
How we handle it: We verify each plan and track authorized visits.
Our Complete Home Health Billing Services
We manage the full home health revenue cycle, from registration and benefit checks to final payment.
1. Eligibility and Authorization Verification
At intake we verify coverage, the plan type and authorization, so care starts with the right payer information. Learn more about insurance eligibility verification.
2. Home Health Coding and Documentation Review
Certified coders review ICD-10-CM diagnoses and supporting records for primary diagnosis and grouping. See our medical coding services.
3. Clean Claim Submission and Follow-Up
Every claim is checked before submission, then tracked with the payer until it is paid, so nothing is forgotten or left unpaid.
4. Denial Management and Appeals
Every denial is worked through root cause analysis, corrected claims and appeals with supporting records. See our denial management solutions.
5. Payment Posting and Patient Billing
We post and reconcile payments, send clear patient statements, and follow up on balances. Read about our accounts receivable services.
Common Home Health Denials and How We Fix Them
Example: a claim denied for missing documentation
The denial. A home health claim is denied with CARC 16 (claim lacks information) because a required item is missing.
How we fix it: We find the gap, obtain the record and resubmit.
Example: a period denied for medical necessity
The denial. A review denies a period with CARC 50 (not deemed a medical necessity).
How we fix it: We appeal with the face-to-face note, plan of care and visit notes.
Specialized Home Health Billing Services
Medicare PDGM Billing
We manage NOAs, final claims and period reviews.
Medicare Advantage and Medicaid
We bill per-visit and authorized services under each plan.
Therapy and Skilled Nursing Visits
We bill nursing, therapy and aide visits. See our physical therapy billing services for outpatient care.
Home Health CPT Codes, HCPCS Codes and Modifiers
These are common home health codes and modifiers we work with. Examples only: coverage and payment vary by payer, so we confirm each one before billing.
| Description | Billing note | |
|---|---|---|
| G0299 | Skilled nursing by RN, 15 minutes | Home health visit |
| G0300 | Skilled nursing by LPN, 15 minutes | Home health visit |
| G0151 | Physical therapy, 15 minutes | Home health visit |
| G0152 | Occupational therapy, 15 minutes | Home health visit |
| G0153 | Speech therapy, 15 minutes | Home health visit |
| G0156 | Home health aide, 15 minutes | Home health visit |
| G0180 | Physician certification | Physician claim |
| G0179 | Physician recertification | Physician claim |
| G0181 | Care plan oversight | Physician claim |
| 0023 | Revenue code for HIPPS line | Institutional claim |
Why Outsource Home Health Billing?
Home Health billing takes specialized knowledge and steady follow-up. Outsourcing to Prospect Healthcare Solutions gives you:
- Lower overhead than a full in-house billing team
- Notice and certification deadline tracking
- Pre-bill review of each period
- Faster follow-up on unpaid claims
- Clear reporting for your owners and managers
Home Health Billing Compliance
We follow HIPAA, CMS and payer rules to reduce your audit risk and build compliance into every step:
- Signed orders on file
- Face-to-face documented
- OASIS completed
- Visit notes retained
- Secure handling of patient information
Who We Serve
Our home health billing services support:
- Medicare-certified home health agencies
- Private home care agencies with skilled services
- Multi-branch agencies
- Hospital-based home health programs
We work with providers nationwide, with office support in North Smithfield, Rhode Island. Find your area on our locations page.
Technology and Reporting for Home Health Billing
We use billing analytics to catch problems early and keep you informed:
- Real-time claim tracking
- Denial patterns by payer and code
- Unbilled period and held claim reports
- Aging accounts receivable reports
- Regular performance reviews
Home Health Billing FAQs
What are home health billing services?
They cover notices, coding review, claims, denial management, payment posting and patient billing for home health agencies.
What is PDGM?
It is the Medicare home health payment model, which pays in 30-day periods based on patient characteristics.
What is a Notice of Admission?
It tells Medicare a home health period has started, and it has a filing deadline.
What is a LUPA?
A low-utilization payment adjustment pays per visit when a period has few visits.
Is a face-to-face visit required?
Yes for Medicare home health, with timing and documentation rules.
How do I get a quote for home health billing?
Request a free billing quote online or call +1 (469) 935-4617. We review your current billing and send a plan and pricing.
Partner with Experts in Home Health Billing Services
Billing should not distract you from care at home. We handle the coding, claims, denials and compliance so your agency gets paid accurately and on time.