Home Healthcare Medical Billing & Credentialing Services

Home healthcare billing requires specialized expertise in complex documentation requirements, OASIS assessments, and strict compliance standards that general medical billing services cannot adequately address. Home health agencies including skilled nursing providers, physical therapy practices, occupational therapy clinics, and chronic disease management programs face unique revenue cycle challenges such as frequent claim denials, evolving CMS payment models, stringent medical necessity requirements, and intricate episode-based billing affecting reimbursement sustainability.

Pro Health Care Advisors delivers comprehensive home healthcare billing solutions designed for small to mid-sized agencies seeking accurate claims processing, reduced denial rates, improved cash flow, and expert guidance navigating the evolving regulatory landscape governing home health and hospice services reimbursement.

Understanding Home Healthcare Billing Complexities

Home healthcare billing differs substantially from facility-based services due to episode-based payment structures, mandatory OASIS documentation for Medicare and Medicaid patients, and time-driven activity requirements that directly determine reimbursement approval or denial. Every home health claim requires comprehensive assessment data including patient functional status, clinical conditions, service utilization patterns, and improvement outcomes supporting appropriate payment category assignment under the Patient-Driven Groupings Model.

Medicare home health payments increased 0.5% in 2025 following budget neutrality adjustments, creating tighter margins requiring precise billing practices maximizing legitimate reimbursement without audit vulnerability. Pro Health Care Advisors implements systematic quality assurance protocols identifying OASIS documentation gaps, coding mismatches between clinical assessments and service codes, missing therapy threshold documentation, and incomplete physician certification statements before claim submission, preventing costly denials and compliance issues.

Comprehensive Billing Services for Home Health Agencies

Skilled Nursing Visit Coding and Documentation Management

Our specialists ensure accurate code selection for skilled nursing services using 99341-99350 for home visits based on complexity levels, G0151 for Medicare skilled nursing, and proper distinction between routine visits versus comprehensive assessments requiring detailed documentation.

Physical Therapy and Occupational Therapy Episode Billing

Physical therapy and occupational therapy billing demands precise documentation supporting medical necessity, tracking therapy minutes toward payment threshold requirements, and proper episode timing ensuring services fall within authorized 30-day or 60-day periods affecting PDGM payment categories.

OASIS Assessment Completion and Quality Reporting

Pro Health Care Advisors manages mandatory OASIS assessments required for Medicare and Medicaid patients aged 18 and older receiving skilled services, ensuring accurate start-of-care, recertification, resumption-of-care, transfer, and discharge assessments supporting appropriate payment determination.

Home Infusion Therapy and Wound Care Claims Processing

Home infusion therapy using codes 99601-99602 requires detailed documentation of medication administration routes, monitoring protocols, and device management, while wound care billing demands precise measurement documentation, debridement coding accuracy, and supplies justification supporting medical necessity.​

Strategic Denial Management Reducing Revenue Loss

Home healthcare agencies experience substantially higher denial rates than other settings due to incomplete patient information, authorization lapses, low-utilization payment adjustments, and insufficient documentation supporting skilled service medical necessity. Common denial triggers include expired physician certifications, services exceeding visit frequency limitations, OASIS assessment submission delays past compliance deadlines, therapy threshold documentation gaps, and claims submitted outside timely filing windows.

Our denial management system tracks patterns specific to home health billing including coordination of benefits errors when patients transition between Medicare Advantage and traditional Medicare, documentation insufficient for requested level of care, and payment disputes regarding episode timing and overlapping service periods. We implement corrective action plans addressing root causes, pursue appeals with payer-specific clinical documentation supporting medical necessity and functional improvement outcomes, and monitor first-pass resolution rates measuring revenue cycle efficiency.

Revenue Cycle Solutions Beyond Claims Submission

Physician Certification and Recertification Tracking Systems

Physician certification statements must be obtained before home health episode begins and recertified every 60 days for continued Medicare coverage, requiring systematic tracking preventing expired certification claim denials. Documentation must clearly establish homebound status, skilled service necessity, and comprehensive treatment plan supporting episode duration and service frequency.​

Electronic Visit Verification Compliance for Medicaid Claims

State Medicaid programs increasingly mandate Electronic Visit Verification documenting exact service times, locations, personnel, and services delivered matching billed claims, requiring EVV system integration with billing platforms ensuring data accuracy. Non-compliance results in automatic claim denials and potential audit penalties affecting agency financial stability.​

Medicare Advantage Prior Authorization Management

Pro Health Care Advisors manages complex prior authorization requirements for Medicare Advantage plans demanding pre-approval for home health episodes, understanding plan-specific authorization criteria differing substantially from traditional Medicare coverage policies. Authorization delays disrupt patient care while postponing revenue, requiring proactive submission tracking and expedited appeal processes.​

Quality Reporting and Value-Based Purchasing Optimization

Home Health Value-Based Purchasing model links reimbursement directly to quality outcomes measured through OASIS data, patient experience surveys, and claims-based quality indicators. Accurate documentation demonstrating functional improvement, reduced hospitalizations, and medication management effectiveness directly impacts payment adjustments and competitive performance ranking affecting agency revenues.

Partner with Specialized Home Healthcare Billing Experts

Home healthcare billing complexity demands dedicated expertise understanding episode-based payment models, OASIS documentation requirements, and evolving CMS policies affecting home health and hospice reimbursement.

Our specialized home healthcare billing services deliver:

• Expert skilled nursing and therapy visit coding accuracy
• OASIS assessment completion supporting optimal payment categories
• Physician certification tracking preventing expired authorization denials
• Electronic Visit Verification compliance for Medicaid claims
• Medicare Advantage prior authorization management
• HIPAA-compliant systems protecting patient health information
• Denial management addressing home health-specific rejection patterns
• Monthly financial reporting with quality outcome tracking

Pro Health Care Advisors brings boutique service quality ensuring your billing team understands home healthcare workflows, knows your payer mix challenges intimately, and advocates persistently for maximum reimbursement on every episode.