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How does home health billing work?

While healthcare profit margins continue to dwindle, the aging population increases. According to the U.S. Census Bureau, by 2030, adults aged 65 and older will outnumber children under the age of 18 for the first time in history!1 That makes it imperative that home health, hospitals, physicians offices, and other healthcare organizations find ways to do more with less. Finding home health billing solutions that streamline the scheduling of physicians and nurses and shortening the turnaround time for Medicare payments is crucial. Learn how home health billing works to navigate the best practices for success.

Step 1: Getting approval for patient services

The first step in home health billing is to connect with the patient and the physician to identify the services needed. The next step is to determine financial responsibility for that care (e.g., any combination of Medicare/Medicaid, supplemental insurance and private pay). Medicare will generally only pay for home health services that involve nursing care, physical therapy, occupational therapy or speech therapy. Home or personal care assistance are generally not covered by Medicare or supplemental insurance plans. Patients also must be homebound and meet a variety of other requirements for 100% reimbursement. With an all-payer eligibility management system, you can manage multiple payers, tasks and activities as well as assign and prioritize patients to keep the billing process moving smoothly.

Step 2: Checking Medicare/Medicaid eligibility

Once you determine the services and timing required, and have assigned the correct billing codes, the next step is checking the patient’s eligibility with Medicare/Medicaid. Havingaccess to Medicare’s HETS database will make checking eligibility much easier as it gives your staff real-time, detailed eligibility and benefits information at the onset of a patient’s stay.

Step 3: Submitting the claims

Once care is provided, you will need to submit the claims to Medicare/Medicaid and to any supplemental insurance companies for payment. With all of the potential for human error in the billing process, automating your Medicare claims submissions can save you time and money. This efficiency can improve your cash flow and maximize your revenue. Automation helps eliminate ongoing follow-ups, reduces multiple contacts with payers and helps ensure the claims are processed without errors.

Step 4: Resolve denials

Because you are working with a variety of physician services, coding numbers, payers, and rules and regulations, there are bound to be times when claims are denied by either Medicare/Medicaid or private insurance. With powerful software solutions like ABILITY EASE All-Payer, you can automate the claims denial process and the correction of complex, multi-step claims. From a single dashboard, you can track appeals and communicate securely to resolve denials and improve cash flow. Automation can also free up your physicians and nurses so they can focus on seeing and treating more patients.

Step 5: Collect balance due from patient

An often overlooked, but important process in home health billing is to collect the balance due through patient payments. It’s important for patients to understand the bill, the itemized charges and the portion of the bill that was paid by insurance. Since only 50% of patients who experience billing difficulties pay their bill in full,2it’s imperative to make patient payments as easy and convenient as possible.

Simplify your home health billing with Inovalon

Home health agencies have plenty to manage without having to worry about billing processes that can easily be upgraded from manual tasks to automated workflows. Whether it’s physician or nurse scheduling or researching denied claims, the powerful automated technology offered by Inovalon can help you. Give us a call today at 888.895.2649 and find out which software systems will work best for your needs. Or, request a no-obligation quote online. We’ll show you how we can increase your revenue cycle management and increase your cash flow!

Older People Projected to Outnumber Children for First Time in U.S. History, U.S. Census Bureau, March 13, 2018,

2 How Patient Experience in Billing Offices Impacts Patient Payments, Sara Heath, Xtelligent Healthcare Media, October 15, 2018,

By Inovalon