Home Health & Hospice Billing Services

Home health and hospice billing run on different mechanics from office billing, and confusing the two is the fastest way to lose revenue in this space. Home health agencies are paid in 30-day periods driven by diagnosis coding and assessment data, while hospice is a separate benefit with its own per-diem levels and revenue codes. Both demand strict timing on admissions, certifications, and claims, and both punish small documentation gaps with payment reductions that cannot be fixed after the fact.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for home health and hospice agencies, built around the period, assessment, and timing rules that actually decide whether these claims pay.

Home health & hospice billing challenges

Home health payment under Medicare follows the Patient-Driven Groupings Model, which pays agencies for 30-day periods of care based on patient characteristics rather than visit volume. The payment group is set by admission source, timing, clinical grouping, functional impairment level, and comorbidity adjustment, all derived from diagnosis coding and the OASIS assessment. A poorly selected primary diagnosis can place a patient in the wrong clinical grouping, and two patients with similar visits can legitimately pay differently because their diagnoses, function, and comorbidities differ. Diagnosis coding therefore carries far more financial weight in home health than procedure coding does.
Timing rules are equally strict. The Notice of Admission must be submitted and accepted within 5 calendar days after the start of care, and a late notice reduces the period payment for each day of delay, with the reduction falling on the agency. A face-to-face encounter must occur within the required window, and certification periods run 60 days, covering two 30-day payment periods. Low-utilization periods, where visits fall below the threshold for the payment group, pay per visit instead of the full period amount. Hospice billing is a separate benefit: a patient generally cannot have home health and hospice paying for the same condition at once, and hospice claims use their own per-diem levels, revenue codes, and terminal diagnosis sequencing, while physician certification and oversight use different codes from home health oversight.
Claim mechanics differ by payer and setting. Medicare home health claims are institutional claims with a HIPPS code for the payment group and each visit reported by discipline, using visit codes that vary by discipline, such as skilled nursing, physical therapy, occupational therapy, speech-language pathology, medical social services, and home health aide visits. Non-Medicare payers often use a different code set for the same visits, so the billing system must route each claim to the right code set for its payer.

What MedPlus RCM handles for home health & hospice practices

• End-to-end medical billing. Charge entry, claim scrubbing, submission, payment posting, and patient billing, the full cycle.
• Medical coding. Certified coders assign current ICD-10, CPT, and HCPCS codes matched to your documentation and specialty.
• Provider credentialing and enrollment. End-to-end enrollment with commercial payers and Medicare, plus re-credentialing maintenance.
• Denial management and recovery. Every denial investigated to root cause, corrected, and appealed with documentation.
• A/R recovery. Aged and outstanding balances audited and pursued, including balances already written off where the appeal window is still open.
• Financial reporting. Clean claim rates, collections, denial patterns, and A/R aging visible by payer and provider.
  We serve home health and hospice organizations of every size, including Medicare-certified home health agencies, hospice agencies, combined home health and hospice organizations, and private-duty agencies that also bill skilled services.

Results home health & hospice practices can check

MedPlus RCM maintains a 99% clean claim rate and keeps client accounts receivable under 30 days. Pricing is a performance-based percentage of successfully collected revenue: if you don’t get paid, we don’t get paid. We are 100% HIPAA compliant, and onboarding takes 2 to 4 weeks depending on practice size, with no disruption to your daily cash flow.

Frequently asked questions

How does Medicare pay home health agencies?
In 30-day periods under the Patient-Driven Groupings Model, based on admission source, timing, clinical grouping, functional level, and comorbidities derived from diagnosis coding and the OASIS assessment.
What happens if the Notice of Admission is late?
The period payment is reduced for each day from the start of care until the notice is accepted, and the reduction is the agency’s liability, not the patient’s.
Can a patient receive home health and hospice at the same time?
Generally no, not for the same condition. Home health and hospice are separate benefits with separate billing rules, and the two must not overlap on the same condition.
Why does diagnosis coding matter more than visit count in home health?
Because the payment group is set by diagnosis, function, and comorbidities, not by how many visits were made. A wrong primary diagnosis can place the patient in the wrong payment group.
How long does it take to switch our billing to MedPlus RCM?
Onboarding takes between 2 and 4 weeks depending on practice size, including data migration and payer clearinghouse setup.
What does MedPlus RCM charge?
A performance-based percentage of successfully collected revenue. If you don’t get paid, we don’t get paid.

Get a free financial audit

Find out where your home health or hospice agency is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
Request your free financial audit