Complete Home Health Billing Solutions
Simplified, Accurate & Future-Ready
Simplified, Accurate & Future-Ready
Stay compliant with PDGM, OASIS-E, and Medicare regulations through 2030.
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With healthcare delivery models shifting dramatically post 2020, home health services have become a vital part of the continuum of care especially for elderly, chronically ill, or recovering patients. As this segment grows, the need for accurate, efficient, and regulation-compliant home health billing services is more critical than ever.
This 2025 guide by Code Credentia covers everything you need to know about home health billing, from foundational concepts to advanced compliance strategies and is designed to remain valid and useful through 2030 as the industry evolves.
Home health billing is the process of submitting claims to Medicare, Medicaid, or private insurers for healthcare services delivered in a patient’s home. It ensures that healthcare providers receive proper reimbursement for services such as:
Skilled nursing care – Registered nurses provide complex medical care like wound treatment, IV therapy, or medication administration.
Physical, occupational, or speech therapy – Rehabilitation therapies to help patients regain mobility, daily living skills, or communication abilities.
Medical social services – Social workers assist patients and families with counseling, community support access, or advanced directives.
Home health aide services – Certified aides help with non-medical tasks such as bathing, dressing, and hygiene under professional supervision.
Medical supplies (like wound dressings)
Unlike standard medical billing, home health billing is governed by unique CMS regulations and visit-based episodic payments, which makes it both specialized and complex.
Patient-Driven Groupings Model (PDGM) – A value-based model that adjusts payments based on patient characteristics, not volume of visits.
OASIS-E Update – The latest clinical assessment tool used to determine payment and ensure care quality; compliance is crucial.
Increased CMS Scrutiny – Medicare audits are more frequent, especially for agencies with poor documentation or billing anomalies.
➡️ Incorrect billing can result in payment denials, audits, penalties, or even legal action. A robust, up-to-date billing process safeguards against these risks.
Why It Matters: Before services begin, it’s crucial to verify insurance coverage, eligibility for home health benefits, and referral documentation.
Steps:
Confirm Medicare Part A eligibility – Check if the patient qualifies for home health under Medicare’s Part A benefits.
Obtain physician orders and a Face-to-Face (F2F) encounter report
Verify frequency and necessity of services – Ensure the care plan is medically necessary and aligned with Medicare’s coverage rules.
OASIS-E is the clinical foundation of home health billing. It must be completed accurately to reflect the patient’s condition and ensure proper case-mix adjustment under PDGM.
Pro Tip: Ensure clinicians are trained in the latest OASIS-E guidance, and use electronic health record (EHR) systems with built-in OASIS validation.
Proper use of ICD-10-CM codes determines payment grouping. Home health agencies don’t use CPT codes for services like other providers, but must code:
Primary diagnosis – The main medical condition that necessitates home health services.
Secondary co-morbidities – Other chronic or acute conditions that may affect the care plan or reimbursement.
Case-mix impacting diagnoses
💡 Top Mistake (2025 update): Coding unspecified diagnoses like “generalized weakness” as the primary cause — now more heavily scrutinized under PDGM audits.
As of 2025, RAPs (Requests for Anticipated Payment) have been replaced by the NOA (Notice of Admission).
NOA must be submitted within 5 calendar days – This starts the payment cycle; missing the deadline leads to daily payment reductions.
Final claim submitted after the 30-day period ends
Use HIPAA-compliant software – Tools must comply with privacy and security regulations to submit claims electronically to CMS MACs.
📌 Tip: Late NOAs can lead to daily payment reductions – use automation and alerts in billing software.
Monitor Electronic Remittance Advice (ERA) files – These provide detailed payment and adjustment information for submitted claims.
Post payments and adjust any Claim Adjustment Reason Codes (CARCs)
Analyze trends in denials or underpayments – Track patterns to improve billing accuracy and reduce delays.
💼 Utilize Revenue Cycle Management (RCM) tools to improve cash flow and identify systemic issues.
2025–2030 compliance watchlist:
Targeted Probe and Educate (TPE) audits by CMS – Focused audits that review claim accuracy and provide feedback before penalties.
Recovery Audit Contractor (RAC) reviews – Independent auditors that look for overpayments and errors across agencies.
PEPPER Reports (Program for Evaluating Payment Patterns Electronic Report)
🔐 Stay audit-ready with:
Thorough clinical documentation – Charting must fully support services rendered and coded.
Clear physician orders – Ensure documentation is signed, dated, and specific.
Up-to-date billing records – Use software and manual audits to avoid errors.
Success in billing also relies on tracking:
Days in Accounts Receivable (A/R) – How long it takes to collect payments after services are rendered.
Clean claim ratio – Percentage of claims accepted on first submission without errors.
NOA timeliness – How consistently NOAs are submitted within the 5-day window.
Denial rate
Average reimbursement per episode
➡️ These KPIs are crucial to agency sustainability and growth.
Consider these top-rated billing platforms as of 2025:
Kinnser WellSky
Axxess Home Health
HCHB (Homecare Homebase)
Alora Home Health Software
Home health billing is not just data entry it’s the financial lifeblood of your agency. With policy updates, billing rule changes, and technological advancements happening regularly through 2030, staying informed is critical.
At Code Credentia, we provide guides and resources that keep your billing accurate, compliant, and efficient so your agency can focus on what really matters: patient care.
NOA (Notice of Admission) replaced RAP in 2022. It notifies Medicare a patient has been admitted for services and must be submitted within 5 days of SOC (Start of Care).
Yes, PDGM continues to define payment structures and is expected to remain the primary model through 2030.
Common reasons include late NOA submission, incorrect diagnosis codes, insufficient documentation, and eligibility errors.
If you’re a home health agency looking for professional billing support, compliance guidance, or software setup assistance, reach out to the Code Credentia experts today.
👉 Request a Free Consultation
📧 Email: info@codecredentia.com
📞 Call: (+1)631-482-7629