Home Health Blogger

How to Get a Prior Authorization for Home Health Billing

Certain payers require prior authorizations.

Depending on the payer, a home health agency (HHA) may be required to obtain a ‘prior authorization’ (PA) for home health billing and to determine insurance eligibility. Think of prior authorization as “permission” to provide a type of...

Posted by Melissa Cott on Apr 20, 2020

PDGM Home Health Billing: Significant Change in Condition (SCIC)

The home health conditions of participation (CoPs) require that agencies update and revise the current OASIS assessment under the following conditions:

(1) The last 5 days of every 60 days if the patient is to be 're-certified', unless there is a beneficiary-elected transfer,

(2) a...

Posted by Melissa Cott on Feb 12, 2020

Medicare Home Health Billing: A RAP is Just a Loan

I am constantly surprised at how many agencies authorize RAP after RAP (Request for Advance Payment) and seem to forget about the final claim. It’s great to get that advance payment and use it as Medicare intended...to keep your agency humming along until the final payment is...

Posted by Trevor Harris on Jan 21, 2019

A Beginner's Guide to Home Health Billing

Home Health billing is full of detail and can be frustrating. Submitting claims to different payers takes ALOT of time because each payer has lots of little rules and terms for which you will be unfamiliar. Your software will only HELP you submit claims but it’s only a tool and you...

Posted by Debbie Bartlett on Mar 8, 2018

Are Your Physicians Billing Home Health Claims for CPO?

'Care Plan Oversight' can earn physicians thousands per month. Provide the following guidance to physicians to enhance your referral-building relationships.

adapted from the Medicare Learning Series: Care Plan Oversight Home Health (CPO) is physician supervision of patients under...

Posted by Melissa Cott on Jan 23, 2018

Denial of Home Health Payments When OASIS Not Received

Medicare Change Request (CR) 9585 directs Intermediaries to automate the denial of Home Health Care Billing Prospective Payment System (HH PPS) claims when the condition of payment for submitting patient assessment data has not been met. Make sure that your HH billing software staff...

Posted by Peggy Mathews on Jan 2, 2017

Medicare is on Warpath for Never-Ending Home Health Recertifications

LAZINESS OR NECESSITY? It’s pretty easy to keep a patient around by sending in a nurse to administer a B12 shot or take vital signs once a week, or perhaps by throwing in an occasional PT visit for home health billing. I’ve watched several agencies recertify patients not just month...

Posted by Peggy Mathews on Nov 14, 2016

Home Health Billing: Get Paid Faster with Perfect Medicare Finals

The path to fast payment of a claim is a no-brainer. Make sure the Final Claim is error-free.  Medicare rejects a claim on an error-by-error basis. You can fix one mistake...but the "inspector" will then re-examine the claim for other inconsistencies. This can be exceedingly...

Posted by Peggy Mathews on Oct 26, 2016