Home Health Billing Services for Medicare-Certified Agencies
Agencies bill in 30-day periods, but each claim depends on people outside the billing office: the practitioner who signs the plan of care, the clinician who completes OASIS, and the scheduler who decides how many visits fall into each period. With our home health billing services, you get a team that knows those handoffs and keeps after them until the final claim can go out.
Problems home health agencies know well
PDGM grouping and diagnosis coding
Medicare pays each 30-day period based on the clinical group from the primary diagnosis, admission source and timing, the OASIS functional score, and comorbidities. A primary diagnosis that isn't accepted for grouping sends the claim back. Vague or unsupported secondary diagnoses can cost you the comorbidity adjustment, so coding has to be specific and backed by the referral and the chart.
NOA timing
The Notice of Admission is due within five calendar days of the start of care. File late and payment is cut for the days before it was submitted, and that money usually can't be recovered. Weekends and holidays are when small intake teams tend to miss it.
LUPA thresholds
A period with fewer visits than its case-mix group's threshold is paid per visit instead of the full period amount. Thresholds differ by group, so schedulers and billers need to look at the same numbers before the period closes.
Certification and signed orders
The face-to-face encounter must relate to the main reason for home care and fall within 90 days before or 30 days after the start of care. The patient has to be homebound and certified, the plan of care signed before the final claim, and OASIS submitted and accepted so the claim matches. Unsigned orders are one of the most common reasons agencies hold claims.
Review Choice Demonstration
Agencies in RCD states have to choose a review option and send documentation on that program's schedule, on top of the usual billing deadlines.
Medicare Advantage, Medicaid and commercial plans
Many Medicare Advantage plans pay per visit or use their own episodic rules, and they authorize by discipline and visit count. Medicaid home health falls under electronic visit verification (EVV), so visit data has to match the claim. Commercial plans bring their own authorization and documentation rules.
Consolidated billing
While a Medicare period is open, the agency is responsible for most nursing, therapy and non-routine supplies. When an outside provider bills for the same services, somebody has to sort out the conflict.
Our Services
How Salyx RCM supports home health agencies
Referral intake
As soon as a referral arrives, we check eligibility for open home health periods, hospice elections, Medicare Advantage enrollment, Medicaid and secondary coverage.
NOAs and authorizations
NOA deadlines are tracked from each start-of-care date. Visit authorizations for Medicare Advantage and commercial plans are requested and monitored by discipline.
Diagnosis coding
ICD-10-CM codes are reviewed by certified coders on our coding team for primary diagnosis acceptability and supported comorbidities, using the referral and the clinical notes.
Pre-billing audit
Before a final claim goes out, we look for a signed plan of care, accepted OASIS, face-to-face documentation, the visit count against the LUPA threshold, and matching EVV data where it's required.
Claims
837I claims for 30-day periods and per-visit payers go out through our claim submission process, and returned or rejected claims are corrected and resent.
Payment posting
Medicare and managed care remittances are posted, and any period paid as a LUPA or with an unexpected adjustment is flagged for review.
AR and appeals
AR and denial follow-up covers held, returned and denied claims, Medicare Advantage appeals and additional documentation requests.
Credentialing
Enrollment with Medicare Advantage, Medicaid managed care and commercial plans is handled by our credentialing staff, who also help keep Medicare enrollment details current.
Patient balances
Where a plan applies cost sharing, as some Medicare Advantage and commercial plans do, patients get clear, itemized statements.
Reporting
Regular financial reports show unbilled periods, documentation holds, NOA timeliness and AR by payer.
Your EMR
We work in home health systems like Homecare Homebase (HCHB), WellSky, Axxess and MatrixCare, and others. Billing runs inside the EMR your clinicians already document in, so OASIS, orders and visit notes don't have to move.
How It Works
Our process
1. Discovery call
We review your census, payer mix, EMR and the reasons claims are on hold.
2. Workflow mapping
We map handoffs between intake, clinical, scheduling and billing staff, with extra attention on signed orders.
3. Onboarding
After a Business Associate Agreement is signed, we set up HIPAA-compliant access, pre-billing checklists and an orders-tracking routine.
4. Weekly cycle
NOAs, eligibility checks, pre-billing audits, claims, posting and follow-up run on a set calendar.
5. Leadership review
Unbilled AR, documentation holds and payer trends are reviewed with your leadership.
Related reading
DME billing
Agencies that also supply equipment can see how we approach DME billing, including capped rentals.
Home infusion
Home infusion follows its own payer rules. Our page on infusion billing explains them.
Insurance follow-up
Why some claims get answers sooner: the psychology behind faster insurance follow-ups.
Frequently Asked Questions
What agency owners and billing managers usually want to know.
1. Do you submit Notices of Admission for Medicare home health?
Yes. We track the start-of-care date for every admission and submit the NOA within the five-day window, as long as we receive the admission information in time.
2. How do you handle unsigned plans of care and orders?
We keep a running list of unsigned plans of care and orders, sorted by certifying practitioner, and share it with your team on a set schedule so follow-up happens before claims are due.
3. Can you bill Medicare Advantage plans that pay per visit?
Yes. Medicare Advantage, Medicaid and commercial plans are billed by their own payment method, whether that’s a 30-day period, an episode or per visit, and authorizations are tracked by discipline.
4. Do you help with OASIS?
Your clinicians complete OASIS; we don’t. Before billing, we confirm it was submitted and accepted and that the claim matches it.
5. Do you support agencies in Review Choice Demonstration states?
Yes. We can organize documentation and track deadlines for the review option you choose. Your clinical team stays responsible for what the documentation says.
Other specialties we serve
Salyx RCM also handles billing for these related specialties.
Hospice Billing
NOE timing, levels of care, certifications and the hospice cap.
Multi-Specialty Billing
E/M leveling, modifiers and global surgery across departments.
Laboratory Billing
Requisitions, medical necessity, CLIA, toxicology and molecular tests.
Behavioral Health Billing
Therapy time codes, telehealth, authorizations and carve-out plans.
Talk with our home health billing team
If unsigned orders, late NOAs or Medicare Advantage authorizations are holding up your cash, tell us which one hurts most. We’ll walk you through how we’d handle it, and the consultation costs nothing. Call (321) 788-3655 or email info@salyxrcm.com to set up a time.