Nuances In Home Health Billing

Posted by Ecareindia on August 29th, 2014

Today many senior citizens in the U.S. prefer to stay at home instead of living in an assisted living or retirement facility. Earlier, these senior citizens were ready to give up their homes and pets to move into a retirement facility. Now, with the availability and assistance of home healthcare professionals, many opt to remain at home. This has created a need for more professional home healthcare providers is rising every day.

What constitutes Home Health?

There are a variety of tasks that Home healthcare professionals handle:

- Personal hygiene

- Medication disbursement

- Food preparation, etc.

There are some home healthcare professionals who accept direct payments and there are many who accept insurance for payment. However, medical claims processing and managing the revenue cycle solutions is consuming a lot of their time and energy.

Thus, home healthcare professionals are outsourcing the maintenance of patient records, negotiations, medical billing and medical coding services to an outsourced medical billing company.

These outsourced medical billing companies provide revenue cycle solutions for Home Health agencies and Providers.

This includes:

· Medical Billing & Collections

· Medical Coding & Clinical document review

· Payment Posting

· OASIS Review

· RAC, ZPIC and ADR Audits

How is Home Health Billed?

The reimbursement is based on a 60-day episode for all the home healthcare services. There are 2 bills generated for an episode:

- RAP (Request for Anticipated Payment) is the first bill that is generated at the beginning of the episode.

- Final Bill (the second and final bill) is submitted at the end of an episode.

These medical claims are submitted at the time of discharge or at the end of an episode.

- The Type of Bill code 329 is used on the final claim for a HH PPS episode.

- Line item detail (including revenue code, HCPCS, units, DOS and Total charges) is provided on all the services rendered.

- In the Value code section, MSA location code is used. If there is any change during the episode, MSA is reported on the final claim.

- Before submitting the RAP, all the necessary documents are made available.

- If Medicare billing/ payment policy requires, the HIPPS line item is reported from the RAP while medical claims processing is handled.

- Same Source of Admission code is mentioned on the RAP and the claim for an episode.

- Appropriate Patient status code is mentioned on the claim for any transfer of patients from one HH agency to another; or return to the Home Health agency during an episode.

- The (18 characters) special treatment authorization number is included as per the new billing requirements. This number consists of the Start date of Care; Assessment date; and assessment reason code.

Apart from the above the outsourced medical billing company must be equipped to handle Home Health consolidated billing, including:

- Medical supplies

- Medical services provided by residents of teaching hospitals or interns.

- Services involving specialized equipment from hospitals, SNFs, and rehabilitation centers.

There are very few offshore outsourced medical billing companies that have the capability to handle the medical claims processing and the complexities of Home Health Billing.

About e-care India:
e-care India offers provider credentialing with total customer satisfaction. With 14 years of experience in the industry, e-care’s 3 offshore medical billing delivery centers have been providing end-to-end medical claims processing and physician credentialing services seamlessly to its clients. To know more about e-care and its services, log on to

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Joined: June 20th, 2011
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