Home Health Billing Services

Home health agencies bill under rules that tie payment to the patient's condition, the timing of admission, and the number of visits. Medicare pays home health in 30-day periods under PDGM. Each period is grouped by case mix, so assessment accuracy and documentation have a direct effect on the claim.

Agencies must also submit a Notice of Admission on time. A late notice can reduce payment. Many agencies also bill Medicare Advantage plans, Medicaid, and commercial payers with different authorization rules. Westmont Revenue Partners connects home health agencies with vetted billing experts who understand these steps and can support the revenue cycle.

Who this is for

• Medicare-certified home health agencies
• New agencies building a billing process
• Multi-branch agency groups
• Agencies with high Medicare Advantage volume
• Administrators and billing managers with aging accounts

What gets billed

• Skilled nursing visits
• Physical therapy visits
• Occupational therapy visits
• Speech-language pathology visits
• Home health aide visits
• Medical social work visits
• 30-day payment period claims
• Notices of Admission
• Low-utilization periods billed per visit
• Managed care and Medicaid home health claims

Commonly billed codes

Code	Type	What it covers
0023	Revenue code	Home health prospective payment line carrying the payment group code
0420	Revenue code	General physical therapy charges
0430	Revenue code	General occupational therapy charges
0440	Revenue code	General speech therapy charges
032x	Type of bill	Home health prospective payment claims
0329	Type of bill	Final claim for a home health payment period
032A	Type of bill	Notice of Admission
G0179	HCPCS	Physician recertification of a home health plan of care
G0180	HCPCS	Physician certification of a home health plan of care
12	Place of service	Home

Note

Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.

Billing challenges in home health

• Notice of Admission timing. Medicare expects the notice within five calendar days of the start of care. A biller tracks admissions daily so no notice is late.
• OASIS accuracy. The assessment affects case-mix grouping and payment. A biller works with clinicians so documentation is complete and consistent.
• Principal diagnosis selection. The primary diagnosis places the period in a clinical group. Coders review charts carefully to select an accurate diagnosis.
• LUPA risk. A period with too few visits may be paid per visit instead of a full period rate. A biller flags at-risk periods early so scheduling can respond.
• Sequential claims. Claims for a patient are processed in order, so one stuck claim can hold up the next. A biller resolves problems quickly.
• Certification and orders. Home health requires signed orders and certification. A biller tracks missing signatures before claims go out.
• Managed care authorizations. Medicare Advantage and commercial plans set visit limits and review rules. A biller tracks authorizations and renewals.

How Westmont can help

• Matching you with vetted billing experts experienced in home health agency billing
• End-to-end revenue cycle support, from referral intake to payment posting
• Denial management and appeal follow-up
• Support with payer enrollment and credentialing
• Help tracking Notices of Admission and open claims

Frequently asked questions

What is PDGM in home health?

PDGM, the Patient-Driven Groupings Model, is the Medicare payment system for home health. Payment is made per 30-day period and is adjusted by case mix, using factors like admission source, timing, clinical group, function, and comorbidities. Agencies should check current-year CMS rules for rate and policy updates.

What is a Notice of Admission?

A Notice of Admission, or NOA, tells Medicare that a home health admission has begun. It replaced the earlier Request for Anticipated Payment. Medicare generally expects it within five calendar days of the start of care. A late NOA can reduce payment for the period, so timing matters.

What is a LUPA?

LUPA stands for low-utilization payment adjustment. If a 30-day period has fewer visits than the threshold for its case-mix group, Medicare pays per visit instead of the full period rate. Agencies can reduce risk by watching visit counts and missed visits during the period.

Why do home health claims get rejected or returned?

Common reasons include a missing or late NOA, an assessment that is not on file, mismatched dates, missing orders or certification, and eligibility errors. A biller checks these items before final billing and fixes errors quickly.

Can a billing company help a new home health agency?

Yes, many new agencies use outside help to set up billing workflows, payer enrollment, and claim tracking. This can free your team for patient care. Ask about experience with home health and how the biller works within your software.

Related billing services

• Hospice
• Nursing Homes
• Physical Therapy
• Occupational Therapy
• Speech-Language Pathology
• Home Infusion Therapy