Home Health Billing, Credentialing

Accurate Coding for Reimbursement

Home health billing requires precise coding of services using the OASIS (Outcome and Assessment Information Set) assessment data along with ICD-10 diagnosis codes and HCPCS codes for procedures and supplies. Getting the coding right is absolutely critical for receiving proper payment from Medicare, Medicaid, and private insurance companies. One small mistake can lead to claim denials or delayed payments that hurt your agency’s cash flow.

Working Through Payer Regulations

Every payer has their own rulebook when it comes to home health billing. Medicare has specific requirements for the types of services covered, frequency limits, and documentation standards. Private insurance companies each have different policies about what they’ll pay for and how much. Home health billers need to stay current with these rules, which change frequently, to make sure claims get paid and your agency avoids audits or compliance issues.

Making Claims Submission Smoother

Most home health agencies use specialized billing software and clearinghouses to handle claims more efficiently. These tools can catch common errors before claims go out the door, which means fewer denials and faster payment. The software can also track where claims are in the process, making it easier to follow up on outstanding payments and keep revenue flowing into your agency.

Managing Denials the Right Way

Even with careful attention to detail, some claims will get denied. That’s just part of the process. What matters is how you handle those denials. Good denial management means figuring out why claims were rejected, appealing them when it makes sense to do so, and learning from patterns to prevent the same mistakes from happening again. This approach helps home health agencies maximize their reimbursement and keep their financial health strong.

Making Sure Providers Are Qualified

Credentialing is the process that verifies your home health providers have the right qualifications, licenses, and professional background to deliver care. Before any nurse, therapist, or aide can provide services that insurance will pay for, they must go through this verification process. It’s not optional. Insurance companies and Medicare require it before they’ll accept claims from your providers.

Keeping Up With Compliance and Quality Standards

The credentialing process takes a close look at each provider’s education, training, current licenses, certifications, work history, and any disciplinary actions or malpractice issues. This thorough review makes sure patients receive care from qualified professionals who meet industry standards. For home health agencies, proper credentialing protects both patients and your business.

Getting Through the Paperwork and Requirements

Different insurance companies have different credentialing requirements, which makes the process time-consuming and sometimes frustrating. You might need different documents for Medicare versus Blue Cross versus Aetna. Home health providers and agency administrators need to gather all the necessary paperwork, submit applications to multiple payers, and keep everything up to date as licenses and certifications come up for renewal.

Services We Provide

• Primary and secondary claims processing
• 24-hour turnaround on claims submission
• Quick follow-up on approved and denied claims
• Posting explanation of benefits (EOBs)
• Correcting patient information
• Clean accounts receivable under 90 days
• Creation of a payer matrix
• Fee schedule setup and maintenance
• Credentialing for new and established providers

Common Home Health Service Types

• Skilled nursing care
• Physical therapy
• Occupational therapy
• Speech-language pathology
• Medical social services
• Home health aide services
• Wound care
• IV therapy and medication administration
• Patient and family education
• Chronic disease management

Common Home Health CPT and HCPCS Codes

• G0154: Direct skilled nursing services (RN) in home health or hospice per visit
• G0155: Direct skilled nursing services (LPN/LVN) in home health or hospice per visit
• G0156: Direct skilled nursing services (RN) per hour in home health or hospice
• G0157: Direct skilled nursing services (LPN/LVN) per hour in home health or hospice
• G0159: Physical therapy or occupational therapy services in home health or hospice, per 15 minutes
• G0160: Speech-language pathology services in home health or hospice, per 15 minutes
• G0162: Home health aide services in home health or hospice, per hour
• G0299: Direct skilled nursing services (RN) in hospice, per hour
• 99500: Home visit for prenatal monitoring and assessment
• 99509: Home visit for assistance with activities of daily living
• S0271: Physician management of patient at home per 30 days
• T1000: Private duty nursing services, up to 15 minutes
• T1001: Nursing assessment and care plan
• T1002: RN services, up to 15 minutes
• T1003: LPN/LVN services, up to 15 minutes

Important Modifiers for Home Health

Using the right modifiers helps ensure proper payment for home health services. Common modifiers include:

• GO: Services delivered under an outpatient occupational therapy plan of care
• GP: Services delivered under an outpatient physical therapy plan of care
• GN: Services delivered under an outpatient speech-language pathology plan of care
• GT: Via interactive audio and video telecommunications systems (telehealth)
• GV: Attending physician not employed or paid under arrangement by the patient’s hospice provider