Comprehensive Home Healthcare Billing Solutions
Home healthcare billing is one of the most complex areas in medical billing due to evolving regulations like PDGM (Patient-Driven Groupings Model) and strict OASIS documentation requirements. We help home health agencies, skilled nursing providers, and therapists navigate these challenges to maximize reimbursements and minimize denials.

Key Services We Bill For:
✅ Skilled Nursing (G0162, G0299) – Ensure proper documentation for wound care, injections, and chronic disease management.
✅ Physical Therapy (G0156, 97110) – Timed vs. untimed services, functional limitation reporting.
✅ Remote Patient Monitoring (G2010, G2012, 99453-99457) – Billing for telehealth and RPM under Medicare.
✅ Home Health Aide Services (T1021, S9125) – Compliance with state-specific rules.
✅ Episodic Care Under PDGM – Avoid LUPA (Low-Utilization Payment Adjustments) penalties.

Critical Home Health Billing Challenges We Solve
1. PDGM Compliance & Reimbursement Optimization
Accurately classify patients into clinical groupings, functional levels, and comorbidity tiers.

Avoid LUPA penalties by ensuring visit thresholds are met.

Properly document “homebound” status (Medicare requirement).

2. OASIS Documentation Errors
Correctly complete E1-E3 items to reflect patient severity.

Link OASIS data to billing codes (e.g., M1800 for mobility limitations).

3. Telehealth & Remote Monitoring Billing
Use G2010 (virtual check-ins) and 99453-99457 (RPM codes) correctly.

Document patient consent and medical necessity for remote services.

4. Common Denials & Fixes
🚩 Denial: “Service not medically necessary”
➔ Solution: Strengthen documentation with functional assessments and care plans.

🚩 Denial: “Missing OASIS data”
➔ Solution: Ensure all E1-E3 fields are completed before claim submission.

🚩 Denial: “LUPA adjustment applied”
➔ Solution: Track visits closely and adjust staffing to meet thresholds.

Why Choose Our Home Healthcare Billing Services?
🔹 Specialized Expertise – We focus exclusively on home health billing, including PDGM, OASIS, and RPM.
🔹 Reduced Denials – Our team catches errors before submission, improving clean claim rates by 40%+.
🔹 Transparent Reporting – Monthly analytics on reimbursement trends, denial rates, and compliance gaps.
🔹 Compliance-First Approach – We ensure adherence to Medicare, Medicaid, and private payer rules.

After switching to our billing service, a Midwest home health agency reduced claim denials by 58% and increased revenue per episode by 22%.