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Specialty Billing

Home Health Agency Billing Services

Home Health Agency Billing & Medicare Compliance

Get a Free Billing Audit 346-307-9057

Specialty Focus

Home Health Agency Billing That Captures What You've Earned

Home health billing operates under the Patient-Driven Groupings Model (PDGM) — a fundamentally different reimbursement framework that rewards clinical complexity and functional impairment over visit volume. Agencies that don't understand PDGM billing leave significant Medicare reimbursement uncaptured on every episode.

Our home health billing team manages the complete PDGM episode billing workflow: RAP submission, OASIS timing, clinical grouping optimisation, and final claim submission. We handle non-routine supply billing, therapy visit documentation compliance, and the prior auth requirements that increasingly apply to Medicare Advantage home health episodes.

97%
First-Pass Clean Claim Rate
24h
Average Claim Submission
40%
Average A/R Reduction
What We Handle

Key Billing Areas for Home Health Agency Practices

Every billing area below is managed by a specialist trained in your specialty's CPT, ICD-10, and payer requirements.

PDGM episode billing & optimisation
OASIS assessment timing & billing
Medicare RAP & final claim submission
Non-routine supply billing
Home health visit coding
Medicare Advantage prior auth
Therapy service billing compliance
Hospice transition billing
Electronic remittance posting
Monthly performance reporting
Why Partner With Us

Built for Home Health Agency Billing Complexity

Specialty-Trained Coders

Our billers are trained in your specialty's CPT codes, ICD-10 diagnoses, and payer-specific rules — not generalists working across 50 specialties.

97%+ Clean Claim Rate

We scrub and submit clean claims the first time, reducing rework, accelerating payment, and improving your net collection rate.

24-Hour Denial Recovery

Every denied claim is reviewed within 24 hours, root cause identified, corrected, and re-submitted before payer appeal deadlines close.

Full HIPAA Compliance

Encrypted data handling, a signed Business Associate Agreement, and annual compliance audits — your patients' information is always protected.

Maximize Your Home Health Agency Revenue

Get a free billing audit and find out exactly how much revenue your practice could be recovering. No contracts, no obligation — just results.

Get Your Free Billing Audit Call 346-307-9057

HIPAA Compliant  •  No Long-Term Contracts  •  Results in 30 Days

Common Questions

Home Health Agency Billing — FAQ

Answers to the questions Home Health Agency practices ask us most before partnering with Prime Medical Billing.

Yes. The Patient-Driven Groupings Model (PDGM) replaced the previous HHRG system and now classifies patients into 432 payment groups based on timing, admission source, clinical grouping, functional level, and comorbidities. We work with your clinical team to ensure OASIS-E documentation captures all elements that maximize appropriate PDGM classification.
RAPs must be submitted within five days of the start of care for a timely filing-compliant payment. We submit RAPs immediately upon receipt of the physician-signed plan of care, track RAP status in our follow-up system, and submit final claims within the 60-day episode billing window.
OASIS-E drives PDGM classification and directly determines payment rates. We audit completed OASIS assessments against medical records to verify accurate functional scoring and comorbidity coding. Incorrect OASIS scoring is among the top audit triggers for home health agencies — our review process protects both revenue and compliance.
Yes. When a patient has Medicare as primary and Medicaid as secondary, we coordinate both claims. We also manage Medicaid-only home health billing, which uses state-specific billing requirements, HCPCS codes for visit types, and service authorization tracking that varies by state.
22 Specialties

We Serve All Medical Specialties

Cardiology Dental Dermatology DME Family Practice Gastroenterology General Surgery Home Health Agency Infectious Disease Internal Medicine Laboratory Mental Health Nephrology Neurology Nursing Home OB/GYN & Women's Health Orthopedic Surgery Pain Management Podiatry Primary Care Rheumatology Urgent Care