Specialty billing · Home Health
The assessment sets the price. We make the claim match it.
247 Medical Billing Services turns every 30-day period into full payment with home health billing services built for PDGM, OASIS accuracy, and on-time Notices of Admission across Medicare, Medicare Advantage, and Medicaid. A dedicated account manager owns your agency, a free 360° reporting dashboard shows every dollar, and HIPAA and SOC 2 Type II safeguards protect it — expertise earned since 2005.
Visits vs LUPA thresholdabove threshold
one visit short = per-visit paymentIn home health, payment is decided long before the claim leaves the building — at the start-of-care visit, in the OASIS assessment, and along the documentation chain that has to be signed, dated, and sequenced exactly right.
5-character HIPPS
The code that prices the 30-day period. We tie the HIPPS on the claim back to the code the grouper produced, so the payment code always matches the record.
Above threshold — full case-mix payment
| Where money is won or lost | What it is | What we manage |
|---|---|---|
| The OASIS-to-HIPPS chain | The OASIS assessment feeds the grouper that assigns the 5-character HIPPS code pricing the 30-day period | Accurate OASIS scoring, the functional-impairment items validated, and a HIPPS tie-out so the code on the claim equals the code the grouper produced |
| PDGM grouping | Admission source and timing (early vs. late), clinical group from the principal diagnosis, functional level, and comorbidity adjustment | The principal diagnosis validated so it groups instead of returning as a questionable-encounter code, and admission source and timing set correctly for each period |
| The LUPA threshold | Each case-mix group's minimum visit count; below it, the period pays per-visit | Visit utilization tracked against the group's threshold so a payable period isn't lost by a single missed visit |
| The eligibility and documentation gate | Timely Notice of Admission, plan of care, face-to-face encounter, and physician certification/recertification | The NOA filed inside its window, the F2F and homebound documentation confirmed, and the certification chain signed and dated before we bill |
| The institutional claim | The 837I / UB-04 with the HIPPS and HH revenue lines, occurrence code 50 for the OASIS assessment date, treatment authorization and condition coding | The full revenue-line set, occurrence and value codes, and the period's line-item visit detail built correctly for each payer |
A home health claim is not an outpatient visit with a few extra signatures attached. Every moving part of the setting is a spot where dollars slip away unnoticed.
The LUPA threshold
It behaves like a cliff, not a ramp.
Each of the twelve PDGM case-mix groups carries its own visit threshold. Come up one visit short and the whole 30-day period drops to a per-visit Low-Utilization Payment Adjustment instead of the full case-mix amount — a swing of hundreds to thousands of dollars decided by a single scheduled visit.
PDGM split the old episode into two 30-day payment periods, each grouped and billed on its own. That doubled the grouping decisions and doubled the number of places a period can downcode.
Score the OASIS or the diagnosis loosely and you either leave acuity revenue on the table or invite a takeback. The clinician-to-coder-to-biller handoff is where payment accuracy is made or broken.
A payable period needs a timely Notice of Admission, a plan of care, a signed and dated face-to-face encounter supporting homebound status and skilled need, and certification — all in order and inside the clock.
In Review Choice Demonstration states, every period is checked against its documentation before or after it pays. Billing without building for that review is how non-affirmed decisions and recoupments happen.
That is a lot of setting-specific machinery to run correctly on every single period — and running it correctly, period after period, is precisely the work a home health billing company is supposed to do rather than learn on your remittances.
We move a home health period from start-of-care to zero balance with one certified team on the same clinical record, not a stack of vendors handing claims back and forth:
The OASIS reviewed for scoring accuracy, the functional-impairment and comorbidity items validated, the principal diagnosis checked so it groups cleanly under PDGM, and the HIPPS on the claim tied out to the code the grouper generated.
The NOA prepared and transmitted inside its filing window on every admission and tracked to acceptance, so no period bleeds payment to a late notice.
Certified coders who know the clinical groupings sequence the principal diagnosis to group correctly and capture the comorbidities that drive the adjustment instead of leaving them off the claim.
Every denial worked to root cause, from face-to-face and homebound defects to NOA-timing, certification, and medical-necessity denials, appealed inside each payer's clock and fed back into intake so it stops recurring.
The agency and its locations enrolled and revalidated across Medicare, Medicaid, and the Medicare Advantage and managed-care plans that drive your census, so nothing rejects on enrollment.
The whole cycle, from eligibility and start-of-care through A/R follow-up and secondary billing, run by a team fluent in home health end to end.
Keep home health billing and coding under one roof and OASIS-driven coding, PDGM grouping, and claim submission stay aligned — instead of being split between an OASIS coder and a separate billing vendor who never see the same record.
Home health is the setting where in-house billing breaks down first.
A single biller has to master PDGM grouping, OASIS-to-HIPPS accuracy, the twelve LUPA thresholds, NOA filing windows, certification calendars, and Review Choice documentation — and stay current as CMS revises every one of them each year.
When that person is out, on leave, or simply behind, periods age past their filing windows, NOAs slip, and LUPA downcodes go uncaught until the remit lands. On the thin margins home health runs on, a few of those in one month is the difference between hiring a clinician and cutting a route.
To outsource home health billing services to 247MBS is to replace that single point of failure with a certified team that already lives inside these rules and a transaction-based fee that scales with your census instead of your payroll.
You stop carrying the cost of recruiting, training, and covering for specialized post-acute billers, and you gain LUPA monitoring, NOA control, and denial analytics that no one-person shop can sustain — while a named account manager and a live dashboard keep the whole operation visible to you.
Revenue review
A certified post-acute specialist reviews your LUPA downcodes, late Notices of Admission, and aged A/R — and puts a number on what they are actually costing.
A home health billing specialist will reach out within one business day.
A home health billing specialist will reach out within one business day.
Bringing us on is not adding a general biller who happens to accept home health claims. It is engaging a home health billing services company that already knows where post-acute revenue leaks:
Visit utilization is tracked against each period's case-mix threshold and at-risk periods are flagged while there is still time to deliver the planned care — so a full payment isn't forfeited to one missed visit.
The functional and comorbidity items are validated and the HIPPS on the claim is tied back to the grouper output, so the payment code always matches the record — which is exactly what reviewers examine.
The Notice of Admission is filed inside its window on every admission and tracked to acceptance, because a late NOA cuts payment for every day it slips.
In demonstration states we assemble the documentation supporting the face-to-face, homebound status, and skilled need before submission, so pre-claim requests come back affirmed rather than non-affirmed.
A named account manager owns your agency and a free 360° dashboard shows every period, denial, and dollar — with no long-term lock-in holding you in place.
Agencies that move their revenue cycle to us typically see:
Our 98% client-retention rate reflects numbers that hold month after month, not just in the quarter after onboarding.
A generalist learns home health on your claims. We arrive already fluent in it — and the gap shows up on the remittance:
Most home health losses trace back to the same short list of failure points. We close each one at the front end, before it becomes a denial, a LUPA, a recoupment, or a documentation request that hardens into an automatic denial:
Notice of Admission filed after its window
Payment reduced for every day the NOA is late
We prepare and transmit the NOA inside its window on every admission and track it to acceptance
Visits fall below the case-mix group's LUPA threshold
Full 30-day period paid as a per-visit LUPA
We monitor visit utilization against the threshold and flag at-risk periods while care can still be delivered
Face-to-face encounter missing, late, or not supporting homebound status
Medical-necessity / eligibility denial (CARC 50)
We confirm the F2F is signed, dated, timely, and documents homebound status and skilled need before we bill
Principal diagnosis maps to a questionable-encounter code that won't group
Return-to-provider; period cannot be grouped or priced
We validate the principal diagnosis groups under PDGM and sequence comorbidities to capture the adjustment
OASIS not submitted, or claim HIPPS does not match the grouper
Claim rejection and case-mix denial
We submit the OASIS on time, carry occurrence code 50 correctly, and tie the claim HIPPS to the grouper output
Plan of care unsigned or certification/recertification late
Certification-defect denial
We run a certification calendar and hold billing until the plan of care and cert chain are signed, dated, and timely
Behind these sits the full CMS contractor stack — Targeted Probe and Educate, Recovery Audit and program-integrity contractors, CERT, and the SMRC — plus the Review Choice Demonstration in participating states and the Home Health Value-Based Purchasing program that puts payment at risk on quality data. We bill in a way that keeps you off those radars and answers them cleanly when they arrive. Request a revenue review and we'll show you which exposure is hitting your remits right now.
The rules shift with the setting and the payer mix, and we bill each one to the detail it demands:
The full PDGM revenue cycle, OASIS accuracy, NOA timing, and LUPA control under one team.
What decides the moneyCase-mix accuracy and denial prevention decide the month
Post-acute home care billed alongside the parent organization.
What decides the moneyFace-to-face, homebound documentation and admission-source coding
Standardized OASIS-to-HIPPS integrity, NOA control, and denial analytics across every location, with one dashboard over the whole footprint.
What decides the moneyConsistency of the grouping chain across branches
Where prior authorization, per-visit and episodic contracts, and plan-specific rules sit alongside traditional Medicare and have to be billed to each plan's clock.
What decides the moneyEach plan's own authorization and filing clock
Mixed post-acute books where clean payer sequencing matters; for the facility side, see our skilled nursing facility billing services.
What decides the moneyClean payer sequencing across lines of business
Changing billers should never open a hole in your cash flow, and with us it doesn't.
We work inside the clinical and billing systems your teams already run — Homecare Homebase, WellSky, Axxess, MatrixCare — so nobody has to relearn a system.
Credentialing and payer-enrollment review run in parallel while your periods keep going out the door, and a named account manager leads the transition from day one.
Most agencies are fully live within a few weeks. As a professional home health billing services partner, we treat that clean handoff as part of the job.
The LUPA recovery, the on-time NOAs, and the faster A/R show up in the first cycles, not a quarter down the road.
Get paid the full value of every 30-day period — that is what medical billing for home health should deliver, and it is exactly what we build for.
247MBS runs home health medical billing as one connected process, so each period prices at its true worth instead of quietly downcoding on a timing miss or a scoring gap no denial report will ever flag for you. You get a first-pass clean-claim rate near 99%, days in A/R pulled under 25, and up to 40% fewer denials, all visible on a live dashboard your named account manager reviews with you. On the thin margins agencies run, that is real money recovered in the first cycles. Request a revenue review
The right home health billing services provider proves itself on the remittance, not the sales call — and that is the standard we hold ourselves to.
What outsourcing looks like with us
Outsource home health billing to 247MBS and you replace a single point of failure with a certified team that lives inside these rules every day — you feel it as fuller, faster payment, never a black box.
You keep your data, your systems, and your payer relationships. Outsourcing simply hands off the part that quietly loses money when it is run part-time — and swaps the cost of recruiting and covering for specialized post-acute billers for a fee that scales with your census instead of your payroll.
Stop giving up periods to timing and turnover or call +1 888-502-0537.
COVERA biller's leave never stalls your cash flow againYOURSYou keep your data, systems and payer relationshipsFEEScales with census, not payrollWhether you run a single Medicare-certified branch, a hospital-affiliated program, or a multi-branch operation, our home health billing services protect every 30-day period, every OASIS, every Notice of Admission, and every dollar of aged A/R. Hand PDGM grouping, LUPA prevention, NOA timing, and Review Choice documentation to a team that treats them as routine — and put the revenue your clinicians have already earned back where it belongs.
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