- 410 Peachtree Pkwy, Suite 4245 Cumming, GA 30041
- Email: info@prohealthcareadvisors.com
- Services
Medical Billing and Practice Management
Creative Collection Solution
MD Audit Shield – RAC
Physician Credentialing
EMR/EHR Software
Electronic Fund Transfer (EFT)
CodeMAXX Services
Hippa
Home Healthcare Billing & Credentialing — Built for Agencies, Hospice & Mobile Care
Home healthcare billing is one of the most regulation-heavy corners of revenue cycle management — PDGM 30-day payment periods, the 5-day Notice of Admission (NOA) window, OASIS-E driven HIPPS coding, and variable LUPA thresholds that silently downgrade payment when visit counts slip.
Pro Health Care Advisors delivers end-to-end home healthcare billing and credentialing built specifically for Medicare-certified agencies, hospice providers, and mobile therapy groups — focused on NOA Timeliness, PDGM Case-Mix Accuracy, and Net Realized Revenue Growth.
Why Agencies Trust Our Home Healthcare Billing Expertise
Generic billing vendors treat home health like office-visit billing. It isn't. A single episode spans OASIS assessments, physician certification, a 5-day NOA clock, 30-day claim cycles, and LUPA math that changes every calendar year. Our team is trained on exactly these moving parts, using AAPC-certified coding standards on every claim.
NOA & 30-Day Period Mastery
The Notice of Admission must reach your MAC within 5 calendar days of start of care — every late day is a non-reimbursable reduction.
We trigger NOA submission automatically off the first billable visit, then manage every subsequent 30-day claim cycle under the CMS Home Health PPS rules — so gap-day penalties never touch your revenue.
OASIS-E → HIPPS Coding Accuracy
PDGM assigns each period to one of 432 case-mix groups driven by OASIS-E responses. We reconcile M-item answers against the clinical record before submission, so your HIPPS code reflects true acuity and survives CMS review.
LUPA Threshold Protection
Every PDGM group carries its own variable LUPA visit threshold, recalibrated annually. Our dashboards flag periods trending toward their threshold mid-period — before payment downgrades to per-visit rates.
F2F & Plan-of-Care Compliance
Face-to-face encounter documentation, physician (or NP/PA allowed-practitioner) certification, and recertification timing are the top home healthcare billing audit triggers. We validate all three on every episode.
Aging AR & Denial Recovery
We specialize in aging agency AR (120+ days) — including medical-necessity and service-area denials. On average, we recover 60–75% of balances agencies assumed were uncollectible.
Dedicated Home Health Account Team
A named Account Manager plus home-health-trained specialists — not a generic call center. A team that knows your census, your disciplines, and your payer mix.
Home Healthcare Billing Across Every Code & Claim Type
From HIPPS-coded 30-day period claims (TOB 32X) to discipline G-codes, hospice notices, and telehealth reporting — our AAPC-certified coders handle the complete home health claim spectrum, with CodeMAXX coding review on every episode.
9 Comprehensive Home Healthcare Billing & Credentialing Services
Standard vendors process claims. We engineer agency revenue integrity. Agencies searching for dependable home health billing services get the complete stack in one engagement — every home healthcare billing engagement includes NOA timeliness tracking, OASIS-to-HIPPS validation, and LUPA monitoring as standard — not as add-ons.
Intake, Eligibility & Homebound Verification
Real-time Medicare/MCO eligibility checks, homebound status documentation, and face-to-face encounter tracking at intake — so episodes start clean instead of starting denied.
OASIS Review & PDGM Coding
Certified coders reconcile OASIS-E responses, primary diagnosis grouping, and comorbidity adjustments. Our CodeMAXX service audits every HIPPS assignment before submission.
NOA / NOE Submission Management
Automated Notice of Admission and hospice Notice of Election workflows triggered off the first billable visit — with daily exception reports so nothing ages past its window.
30-Day Period Claims & Scrubbing
Home-health-specific scrubbing covers occurrence codes, condition codes, visit-count math, and sequential billing rules across every MAC and managed care payer.
Payment Posting & Variance Detection
Automated remittance processing with contracted-rate variance flagging. When a payer underpays a period or misapplies a LUPA, we catch it and file formal disputes on your behalf.
Denial Management & Medicare Appeals
We eliminate repeat denials — F2F documentation, medical necessity, service area — and file appeals through all five levels per the CMS Medicare appeals process.
Accounts Receivable Follow-Up
Our home healthcare billing recovery team pursues revenue most agencies assume is permanently lost — averaging 60–75% recovery on written-off AR.
Agency Credentialing & Enrollment
Our credentialing team manages CMS-855A enrollment, branch and sub-unit updates, accreditation coordination, monthly OIG/SAM exclusion sweeps, and clinician license renewals.
Agency RCM Analytics & Reporting
Days in AR, LUPA rate by team, denial rate by discipline, and payer-specific performance — part of our full medical billing and practice management platform.
Your Agency's Revenue Cycle Is Leaking. We'll Show You Where.
Most home health agencies lose 8–12% of potential revenue to late NOAs, LUPA downgrades, and aging AR write-offs. Get a complimentary Agency Payer Performance Audit — benchmarking your current home healthcare billing performance with zero obligation.
No sales pitch. No obligations. Just data.
Home Healthcare Billing for Every Agency Model
Each care model bills differently — PDGM periods vs. hospice per-diems, Medicare FFS vs. managed care authorizations, single-site vs. multi-branch enrollment. We staff for all of them.
Medicare-Certified Home Health Agencies
Full PDGM lifecycle — NOA filing, OASIS-E coding, 30-day period claims, LUPA and PEP management, and recertification tracking during the final 5 days of each 60-day certification period.
Hospice Providers
Notice of Election filing, all four levels of care (routine home care, continuous, GIP, respite), service-intensity add-ons, and attending-physician coordination — hospice billing handled end to end.
Private Duty & Non-Medical Care
Medicaid waiver programs, EVV (Electronic Visit Verification) compliance, long-term-care insurance invoicing, and private-pay statement cycles for hourly and live-in care models.
Mobile Therapy Groups (PT / OT / SLP)
Discipline G-code accuracy (G0151–G0160), therapy reassessment timing, and maintenance-therapy documentation that keeps visits payable under medical-necessity review.
Home Infusion & Specialty Programs
Home infusion therapy benefit billing, per-diem professional services, and pre-certification lifecycles for high-tech home therapies including wound care and IV programs.
Multi-Branch & Multi-County Groups
Branch enrollment updates, sub-unit NPIs, and service-area management that prevent the county-boundary claim rejections that quietly drain expanding agencies.
High-Impact Home Healthcare Billing Items We Manage Daily
These claim elements drive the majority of agency revenue — and the majority of agency denials. NOA timing, HIPPS accuracy, and LUPA math are where our team earns its keep.
| Claim Element | Category | Common Denial / Loss Trigger | Our Safeguard | Status |
|---|---|---|---|---|
| NOA (Notice of Admission) | Admission filing | Missed 5-day window — per-day payment reduction | Auto-trigger off first billable visit + daily exceptions | ✓ Covered |
| HIPPS / OASIS-E | PDGM case-mix | Under-scored function & cognition items | M-item reconciliation vs. clinical record | ✓ Covered |
| LUPA thresholds | Payment adjustment | Visit counts slipping below variable threshold | Mid-period trend alerts by group | ✓ Covered |
| Face-to-Face encounter | Certification | Missing / late F2F documentation | Episode-level F2F validation at intake | ✓ Covered |
| TOB 322 / 329 claims | 30-day periods | Sequential billing & occurrence-code errors | Home-health-specific claim scrubbing | ✓ Covered |
| Therapy G-codes | Discipline visits | Reassessment timing & maintenance documentation | Discipline-level utilization review | ✓ Covered |
| RPM / telehealth reporting | Bundled services | Billed as separate line items (non-payable) | Cost-report allocation & compliant claim mapping | ✓ Covered |
Getting Started with Home Healthcare Billing: Our 5-Step Onboarding
From your first free agency assessment through full revenue cycle management — onboarding takes less than two weeks.
Free Agency AR Assessment
We analyze your home healthcare billing performance, NOA timeliness, LUPA rates, denial categories, and payer mix.
Credentialing & Enrollment Audit
We verify CMS-855A status, branch enrollments, accreditation alignment, and payer contracts — catching gaps before they delay reimbursement.
EMR Integration
We connect to your agency platform — Axxess, WellSky, Homecare Homebase, MatrixCare, and more — no migration required.
Active Billing & Compliance
Certified coders manage claims from intake to payment posting with continuous NOA, OASIS, and LUPA monitoring.
Monthly Agency Reporting
Real-time dashboards plus monthly optimization recommendations for your home healthcare billing performance.
Built-In RAC Audit Defense for Every Home Healthcare Billing Client
Home health agencies face some of the heaviest federal audit scrutiny in Medicare. Every agency client receives our MD Audit Shield program — proactive audit prevention and full federal audit defense at no extra charge.
Proactive — Not Reactive
F2F documentation, OASIS accuracy, and visit-count math are validated continuously — not reconstructed under audit pressure after an overpayment demand arrives.
AAPC-Certified Coding Accuracy
Certified coders validate every diagnosis grouping, HIPPS assignment, and G-code — eliminating the case-mix triggers that put agencies on RAC lists.
All 5 Medicare Appeal Levels
From Redetermination through Federal District Court — home-health-specific documentation packets at every level of the CMS appeals process.
HIPAA-Compliant Workflows
AES-256 encrypted document handling and BAA management built into every billing and audit workflow — agency and patient data stay protected.
Real-Time Compliance Reporting
Live dashboards showing your agency's audit risk profile, open appeals, and claim compliance metrics at all times.
Dedicated Audit Response Team
A named specialist manages your agency's account — not a call center. You always know who is handling your defense.
Home Healthcare Billing — Frequently Asked Questions
HHAs must submit a one-time NOA to their Medicare Administrative Contractor within 5 calendar days of the start-of-care date — every late day creates a non-reimbursable payment reduction.
Our home healthcare billing team triggers NOA submission automatically off the first billable visit, with daily exception reporting, so gap-day penalties never touch your revenue.
PDGM assigns each 30-day period to one of 432 case-mix groups, and OASIS-E functional and cognitive items directly drive that assignment per the CMS Home Health PPS.
Our coders reconcile clinician M-item responses against the clinical record before submission, so your HIPPS code reflects true patient acuity and survives CMS medical-necessity review.
Under the home health benefit, telecommunications and RPM services are currently bundled into the 30-day period payment rather than paid as separate line items.
We make sure your RPM costs are correctly captured on the cost report — protecting your future base-rate valuations while keeping claims compliant.
Yes. Each of the 432 PDGM groups carries its own variable LUPA visit threshold, recalibrated annually by CMS.
Our dashboards flag every 30-day period trending toward its threshold mid-period — giving your clinical team time to review visit utilization before the period downgrades to per-visit payment.
Expanding into a new county often requires a branch enrollment update or sub-unit NPI to prevent service-area claim rejections.
Our credentialing team manages CMS-855A updates, accreditation coordination (ACHC, CHAP, Joint Commission), and monthly OIG/SAM exclusion sweeps across every branch you operate.
Explore More Medical Billing & Credentialing Resources
Home healthcare billing is one of 30+ specialties we serve nationwide — alongside dedicated home health billing programs for every care model above.
Wound Care Medical Billing & Credentialing
Wound care and home health overlap constantly — NPWT devices, supply billing, and visit documentation for chronic wound patients treated at home.
Wound Care Billing →Family Practice Medical Billing & Credentialing
Family practices drive the referral and certification chain for home health — see how we manage the physician side of the episode.
Family Practice Billing →Agency & Clinician Credentialing Services
Full-lifecycle credentialing — CMS-855A enrollment, CAQH management, OIG/SAM exclusion monitoring, and commercial payer contracting.
Credentialing Services →30+ Medical Billing Specialties We Serve
From mental health and cardiology to pathology and urology — explore every specialty-specific billing program we offer.
View All Specialties →