Home Health and Hospice Billing Services

Home health and hospice are billed on deadlines rather than on codes. Miss a Notice of Admission window and the payment for that entire period is reduced. Miss a Notice of Election and the days before it are not payable at all. The clinical work is done either way.

Our home health billing services and hospice billing services are built around those deadlines, and we handle the agency enrollment that has to be in place first. Agencies searching for billing home health services, billing for home health services, nursing home billing services or a hospice credentialing service are usually describing one of the workflows below.

Becoming a Medicare-certified agency

Home health and hospice agencies enroll as institutional providers, which is a longer road than a physician practice:

• CMS-855A enrollment through PECOS, with the full ownership disclosure that institutional enrollment requires.
• Accreditation by a CMS-approved body, ACHC, CHAP or The Joint Commission, or a state survey. This is the long pole; budget months, not weeks.
• Survey and certification, then a CMS Certification Number (CCN) before you can bill Medicare.
• Capitalisation requirements for new home health agencies.
• Medicaid and Medicare Advantage enrollment separately, each MA plan on its own paperwork.

We handle the enrollment and the payer applications; the accreditation survey itself is your accrediting body's process, and we will tell you plainly where our work ends.

PDGM: how home health is actually paid

The Patient-Driven Groupings Model pays in 30-day periods, not 60-day episodes, and the case-mix weight for each period is built from:

Because the principal diagnosis drives the clinical grouping, a vague or unacceptable primary code can push a period into a lower-weighted group or make the claim unbillable. We review coding against the OASIS before the claim goes out, not after.

Notice of Admission

The NOA replaced the old Request for Anticipated Payment. One NOA is filed per admission, within five calendar days of the start of care. File it late and the payment for the period is reduced by a percentage for each day of delay, a penalty that is entirely administrative and entirely avoidable.

We file NOAs as admissions happen and monitor the five-day clock daily, because it is the single highest-value deadline in home health billing.

Hospice: Notice of Election and the cap

• Notice of Election (NOE) must be filed within five calendar days of the election date. Filed late, the days from election to filing are not covered and cannot be billed to the beneficiary either.
• Levels of care, routine home care, continuous home care, inpatient respite and general inpatient, are paid at different per-diem rates, and routine home care itself pays a higher rate in the first 60 days.
• The Service Intensity Add-on applies to qualifying visits in the last seven days of life.
• The aggregate cap limits total payment per beneficiary per cap year. Agencies that exceed it repay the difference, sometimes long after the money was spent. We track cap exposure through the year rather than discovering it at reconciliation.

Agency credentialing with Medicaid and MA plans

Home health credentialing is agency-level work, not clinician-level. Each Medicaid program and each Medicare Advantage plan enrolls the agency separately, verifies the license and accreditation, and issues its own contract and rate. MA plans in particular often pay per visit rather than per period, which is a different billing workflow from traditional Medicare on the same patient.

See our credentialing services for how we run agency enrollment alongside the billing.

What we do every week

• NOA and NOE filing monitored against the five-day clock.
• OASIS and diagnosis review before the period claim is built.
• Period and per-diem claims filed and tracked.
• Eligibility checks, including hospice election status and MA enrollment.
• Denial management and additional documentation requests.
• Hospice cap monitoring through the cap year.
• Payment posting and reconciliation against the expected case-mix weight.
• Aged AR recovery and monthly reporting.