Billing Services for Home Health Agencies

Home health reimbursement runs on a completely different clock from outpatient care — OASIS assessment timing, PDGM 30-day payment periods, NOA (Notice of Admission) requirements and Medicare Advantage plans imposing prior-auth on episodes that traditional Medicare doesn't. Afiablee delivers home-health-specific RCM tuned to these realities.

PDGM Episode Billing

Each 30-day payment period requires accurate clinical grouping, comorbidity adjustment and timing category — errors here directly reduce per-episode payment. We validate every PDGM HIPPS code against the OASIS and primary diagnosis before claim submission.

HIPPS code validation against OASIS
Primary diagnosis sequencing for clinical grouping
Comorbidity adjustment optimization
Notice of Admission (NOA) timely filing tracking

Medicare Advantage Authorization Workflow

Unlike traditional Medicare, MA plans typically require prior authorization for home health episodes and concurrent re-auth for extensions. We manage the authorization lifecycle alongside the clinical team.

Initial episode authorization per MA payer
Concurrent re-authorization for extensions
Payer-specific documentation submission
Denied-authorization appeals coordination

Home health clinician documenting OASIS assessment on tablet — OASIS-driven coding + PDGM episode billing + MA authorization workflow.

OASIS-Coding Alignment

OASIS M-items drive PDGM payment but often don't align with the clinical narrative. Our coders flag OASIS-documentation conflicts back to QA before the assessment locks.

Operational Challenges We Solve

Late NOA filings triggering payment reductions
PDGM HIPPS miscoding suppressing episode payment
MA authorization denials on extension requests
OASIS-to-claim diagnosis sequencing errors
LUPA threshold mismanagement
Therapy visit utilization documentation gaps

Discuss Your Organization's Needs

Speak with a specialist about how our RCM workflows adapt to billing services for home health agencies.

Contact Our Team