Home Health Billing Services
Home health billing services for Florida agencies. PDGM 30-day periods, OASIS-matched claims, NOA filing, and denial management.
How Home Health Billing Is Structured
Home health is paid in 30-day periods under PDGM, and the claim depends on a completed assessment and a timely notice of admission. Missing the notice window reduces payment for the period regardless of the care delivered.
- Notice of admission filed inside the required window
- Claims matched to the completed assessment before submission
- 30-day payment periods tracked across the episode
- Low-utilisation periods identified and billed correctly
Home Health Billing Explained
Home health billing in Florida runs on rules that no other care setting uses. Since January 1, 2020, Medicare pays home health agencies under the Patient-Driven Groupings Model (PDGM): a national, standardized payment for each 30-day period of care, adjusted for case mix and geographic wages, with low-visit periods paid per visit under the Low Utilization Payment Adjustment (LUPA). Every claim must match a completed OASIS assessment to process, and claims are submitted as institutional claims on the UB-04 (837I) with type of bill 32X per CMS home health billing requirements.
Medsure RCS manages home health billing for agencies across Florida, from Notice of Admission (NOA) filing within the 5-calendar-day window through 30-day period claims, OASIS-to-claim matching, and denial management. Florida is one of the highest home health utilization states in the country because of its Medicare-age population, and Florida Medicaid managed care plans add their own authorization and billing rules on top of Medicare. Home health is part of our specialty medical billing program, built on the same disciplined medical billing workflows we run for every specialty.
How It Works: Step by Step
NOA Filing and Eligibility Verification
The Notice of Admission is submitted to the MAC within 5 calendar days of the start of care, with Medicare eligibility, homebound documentation, and face-to-face encounter requirements verified before billing begins.
OASIS and Coding Alignment
OASIS assessment data, primary diagnosis coding, and the physician-signed plan of care are aligned so the HIPPS code and case-mix grouping on the claim match the assessment on file.
30-Day Period Claim Submission
Claims for each 30-day payment period are prepared on the UB-04 (837I, type of bill 32X) with required CBSA and FIPS value codes and submitted after the period ends.
LUPA Review, Payment Posting, and Follow-Up
Low-visit periods are reviewed for LUPA per-visit payment accuracy, remittances are posted, and underpaid or denied periods enter structured follow-up and appeal workflows.
Why This Matters for Your Revenue Cycle
Every admission is tracked against the 5-calendar-day NOA deadline, preventing the 1/30th per-day payment penalty for late filing.
Every 30-day period claim is verified against the completed OASIS assessment before submission so claims are not returned.
Home health-specific edits for type of bill 32X, value codes, and HIPPS coding drive first-pass acceptance above 95%.
Face-to-face encounter documentation is confirmed for every certification before claims are billed.
Common Mistakes in Home Health Billing
Filing the NOA Late
The Notice of Admission is due within 5 calendar days of the start of care. Every day of delay costs 1/30th of the wage and case-mix adjusted 30-day payment, and for LUPA periods, per-visit payments are lost entirely for days before the NOA is submitted.
Claims That Do Not Match the OASIS Assessment
Under PDGM, Medicare matches each home health claim to the OASIS assessment on file. Claims submitted before the OASIS is completed and transmitted, or with coding that conflicts with the assessment, are returned or denied.
Missing Face-to-Face Encounter Documentation
Medicare requires a documented face-to-face encounter within 90 days before or 30 days after the start of care, related to the primary reason for home health. Missing or unrelated encounter documentation makes the entire episode unbillable.
Mishandling LUPA Periods
30-day periods that fall below the visit threshold are paid per visit rather than at the full period rate. Billing a LUPA period as a standard period, or failing to track visit counts near the threshold, produces incorrect payments and repayment exposure.
How Medsure RCS Manages Home Health Billing
NOA and Timely Filing Management
Notices of Admission are prepared and submitted within the 5-calendar-day window for every admission, with deadline tracking and confirmation from the MAC.
PDGM 30-Day Period Billing
Period claims are built with correct HIPPS coding, case-mix alignment, and the CBSA and FIPS value codes required on every type of bill 32X claim.
OASIS-to-Claim Verification
Every claim is checked against the completed OASIS assessment before submission so coding, dates, and case-mix data agree.
Eligibility and F2F Compliance
Homebound status, skilled need, physician certification, and face-to-face encounter documentation are verified for every certification period.
Florida Medicaid Home Health Billing
Home health claims for Florida Medicaid managed care plans are billed with plan-specific authorization and documentation requirements.
Home Health Denial Management
Denied periods are analyzed by reason code and appealed with OASIS, plan of care, and encounter documentation matched to the payer criteria.
Home Health Billing, Frequently Asked Questions
The Patient-Driven Groupings Model is the Medicare payment system for home health, effective January 1, 2020. It pays agencies a standardized rate for each 30-day period of care, adjusted for case mix and geographic wages. Periods with visit counts below the LUPA threshold are paid per visit instead. Billing accuracy depends on correct OASIS data, diagnosis coding, and period tracking.
Since January 1, 2022, home health agencies file a one-time Notice of Admission with their Medicare Administrative Contractor instead of the old Requests for Anticipated Payment. The NOA is due within 5 calendar days of the start of care. Late filing reduces payment by 1/30th of the period amount for each day of delay.
Yes. Florida Medicaid covers home health primarily through Statewide Medicaid Managed Care plans, each with its own authorization rules, visit limits, and claims requirements. We verify the patient's specific plan enrollment, obtain plan authorizations, and submit claims to the correct managed care organization.
Medicare requires a physician-signed plan of care and certification, documentation that the patient is homebound and needs intermittent skilled care, a face-to-face encounter within 90 days before or 30 days after the start of care, and a completed OASIS assessment that matches the claim. We verify all of these before any claim is submitted.
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