Home Infusion Billing Services
Home infusion billing has more moving parts than most. Drugs, supplies, nursing visits and per diems all follow different payer rules. Salyx RCM helps home infusion providers get paid accurately and on time.
Home infusion is one of the hardest services in healthcare to bill. A single patient on IV antibiotics can generate a drug claim, a pump and supply claim, a nursing visit claim and, for some Medicare patients, a separate professional services claim, each going to a different payer contractor under different rules. Commercial plans often roll most of it into a daily per diem instead. When the pieces are not lined up before the first dose, the result is denials, write-offs and patients who get bills they did not expect.
Salyx RCM provides home infusion billing services for home infusion pharmacies, specialty pharmacies with infusion programs and infusion nursing providers. We map each payer's structure up front and then handle intake, authorizations, claims and follow-up so your clinical team can stay focused on patients. If you also bill pumps and supplies as a DME supplier, our DME billing services cover that side of the work.
Our home infusion billing services
Referral intake and benefits verification
We confirm whether therapy falls under the medical or pharmacy benefit, check Medicare Part B versus Part D coverage, and review deductibles, coinsurance and network status before the patient starts.
Prior authorization
We request and track authorization for the drug, per diem, nursing visits and equipment, and start re-authorization before approved dates or visit counts run out.
Medicare Part B DME claims
We bill external infusion pumps such as E0779 and E0781, related supplies and covered drugs to the DME MAC, with the orders, documentation and modifiers the external infusion pump policy requires.
Home infusion therapy services benefit
For qualified home infusion therapy suppliers, we bill G0068, G0069 and G0070 professional services for the correct drug category and visit days, separately from the DME claim.
Commercial per diem and nursing claims
We bill per diem S-codes, nursing visits and drug lines according to each contract, and keep carve-outs for drugs and nursing straight.
Payment posting, AR and denials
We post every line, compare payments against contract terms, work denials by root cause and prepare appeals with the clinical support payers ask for.
Home infusion billing challenges we solve
Medicare coverage split across parts
Medicare Part B covers certain home infusion drugs only when given through a covered external infusion pump under the DME benefit. Most other home infusion drugs fall under Part D, which covers the drug but generally not the pump, supplies or nursing. Billing the wrong part leads to denials and patient balance problems.
The home infusion therapy services benefit
The Part B home infusion therapy (HIT) services benefit pays qualified suppliers for professional services such as nursing, training and monitoring on days a professional is in the home. G0068, G0069 and G0070 map to specific drug categories, and the claim goes to the A/B MAC, not the DME MAC that pays for the pump and drug.
Per diem billing for commercial payers
Many commercial and Medicaid plans pay a daily per diem S-code that bundles pharmacy services, supplies and equipment, with the drug and nursing billed separately. Which items are included varies by contract, so posting and underpayment review have to follow each one.
Nursing visits
Home infusion nursing may be billed per visit or per hour depending on the payer. Visit notes need the dates, times and services that support the codes billed, and visits often need their own authorization.
Prior authorization and re-authorization
Specialty drugs, immune globulin and long courses of IV therapy usually need authorization tied to diagnosis, dose, frequency and duration. Changes in the order mid-therapy can require a new or updated authorization.
Documentation and proof of delivery
Medicare DME claims for pumps and drugs need a valid order, supporting medical records and proof of delivery. Missing pieces are a common reason for denials and post-payment review findings.
Our home infusion billing process
- Discovery call. We learn about your therapies, payer mix, Medicare enrollment status, pharmacy and billing software and current pain points.
- Payer mapping. We document how each major payer pays drugs, per diems, equipment and nursing, including authorization rules and which items are bundled.
- Onboarding. We set up secure access, intake checklists and an escalation path to your pharmacists and nurses for documentation questions.
- Daily operations. We handle verification, authorizations, claims for each component, posting and follow-up on open balances.
- Regular review. We review denials, underpayments, upcoming re-authorizations and open AR with your team and agree on fixes.
Why home infusion providers choose Salyx RCM
We build your workflow around how each payer actually pays, not a generic template, and we keep you informed with clear reporting.
ISO 9001 and ISO/IEC 27001 certified
Quality and information security standards that are independently audited.
HIPAA-compliant by design
PHI is handled on secure systems with access controls and trained staff.
Trusted by 500+ providers
Practices, groups and suppliers across the US rely on our team.
Fast, paperless workflows
100% paperless processing with a turnaround under 24 hours.
Learn more about getting authorizations right the first time in our article on fixing prior authorization delays at the front end, or see our infusion billing services for infusion centers and physician offices.
Get a free billing audit. No cost, no obligation.
We'll review a sample of your home infusion claims and denials and show you where revenue is slipping.
Frequently Asked Questions
Do you bill Medicare Part B and Part D home infusion claims?
Yes. We bill Part B claims for external infusion pumps, supplies and covered drugs to the DME MAC, and we help you route drugs covered under Part D to the right plan so claims are not sent to the wrong payer.
What is the home infusion therapy services benefit?
It is a Medicare Part B benefit that pays qualified home infusion therapy suppliers for professional services, such as nursing and patient training, on days a professional visits the home. These services are billed with G0068, G0069 or G0070 depending on the drug category.
How do you bill commercial per diem codes?
We bill the per diem S-code for each day of therapy as the contract allows, then bill the drug and nursing visits separately when they are not included. We check payments against each contract to catch underpayments.
Can you handle prior authorization for home infusion therapy?
Yes. We request authorization for the drug, per diem, nursing and equipment, track approved dates and units, and start re-authorization before approvals expire.
Do you bill nursing visits for home infusion?
Yes. We bill nursing visits per visit or per hour based on the payer's rules and review visit notes for the details that support each claim.
How do I get started?
Request a free billing audit or call (321) 788-3655. We'll review a sample of your claims and walk you through what we found.