Home health and hospice billing and revenue cycle management
Home health and hospice RCM manages revenue in two heavily regulated Medicare programs: filing admission and election notices on time, keeping certifications and orders current, billing 30-day home health periods or hospice levels of care, and following up on denials. Medalyze helps agencies keep those deadlines and claims on track.
Why is home health and hospice billing so deadline-driven?
In most specialties a missed step means a denied claim you can fix. In home health and hospice, a missed deadline can mean days or entire periods of care that can't be billed at all.
Home health
- Notice of Admission (NOA). Medicare home health agencies must submit an NOA within five calendar days of the start of care. A late NOA can reduce payment for the days before it was filed.
- 30-day payment periods under PDGM. Payment is based on 30-day periods, with case-mix factors drawn from the clinical grouping, functional level, comorbidities, admission source and timing. The OASIS assessment drives much of this, so an inaccurate assessment affects payment directly.
- Face-to-face encounter and certification. The patient must have a qualifying face-to-face encounter with an allowed practitioner and be certified under a plan of care signed by the physician or allowed practitioner. Missing or late documents delay billing.
- LUPAs and outliers. Periods with too few visits are paid at a low-utilization rate, and unusually high-cost periods can trigger outlier payments, so visit counts need tracking.
- Medicare Advantage. Many patients are in Medicare Advantage plans that require authorization and have their own rules.
Hospice
- Notice of Election (NOE). Hospice agencies submit an NOE within five calendar days of the election date. A late NOE makes the days before it non-billable for the agency.
- Levels of care. Routine home care, continuous home care, inpatient respite and general inpatient care are billed under different revenue codes, and each has documentation requirements for the level billed.
- Benefit periods and recertification. Patients are certified in benefit periods, with face-to-face recertification starting at the third period, and a lapse can stop billing.
- Caps and reviews. Medicare applies an aggregate cap on hospice payments, and hospices are subject to medical review, so documentation of terminal prognosis needs to be consistent.
What does Medalyze do for home health and hospice agencies?
- Eligibility and enrollment checks. We confirm Medicare or Medicare Advantage eligibility, benefit status and whether another hospice or home health provider is already involved.
- Deadline tracking. We track NOA and NOE deadlines, certification and recertification dates, and order signatures so documents are filed and signed in time.
- Authorization management. For Medicare Advantage and Medicaid patients, we track authorization requests, approved visits and expiration dates.
- Claims. We prepare and submit final claims, check them against payer edits, and reconcile them with the clinical record before billing.
- Payment posting. Remittances are posted by claim and period, with attention to adjustments, reductions and recoupments.
- Denial management and AR follow-up. We work rejections and denials by cause and track which stage in intake or documentation is producing them.
- Provider enrollment. We help with Medicare and Medicaid enrollment, and with keeping ordering and certifying physicians properly enrolled, since orders from a non-enrolled practitioner can cause denials.
- Reporting. Days in AR, claims held for missing documents, NOA and NOE timeliness, and denial reasons.
Which rules matter most?
| Area | Examples |
|---|---|
| Home health | NOA within 5 calendar days, 30-day PDGM periods, OASIS, face-to-face encounter, certification and plan of care, LUPA |
| Hospice | NOE within 5 calendar days, levels of care (routine, continuous, respite, general inpatient), benefit period certification, face-to-face recertification from the third period, aggregate cap |
| Common denial drivers | Late notices, missing signed orders, ordering practitioner not enrolled, authorization gaps for Medicare Advantage, documentation that doesn't support the level of care |
Who is this for?
Home health agencies and hospices that are growing census, adding locations or switching software, and small agencies where one person manages intake, documentation and billing.
Frequently asked questions
What is a Notice of Admission in home health?
It is a one-time notice that Medicare home health agencies submit to start a period of care. It replaced the old Request for Anticipated Payment. It is due within five calendar days of the start of care, and filing late can reduce payment.
What is a Notice of Election in hospice?
It's the notice a hospice sends to Medicare when a patient elects the hospice benefit. It's due within five calendar days of the election date, and days before it is filed are generally not billable by the hospice.
What does PDGM mean?
PDGM stands for Patient-Driven Groupings Model. It is the payment system Medicare uses for home health, paying per 30-day period based on patient characteristics instead of the number of therapy visits.
Can you work with Medicare Advantage patients?
Yes. We check eligibility and track authorizations, because Medicare Advantage plans often have their own requirements separate from original Medicare.
Do you provide clinical coding or OASIS review?
We support billing and revenue operations. Clinical assessment and OASIS accuracy should stay with your qualified clinicians, and we can work with their documentation to catch billing issues.
Related services: eligibility and benefits verification; provider credentialing and enrollment; claim creation and submission; payment posting; denial management; accounts receivable follow-up.
Related reading: CMS electronic prior authorization 2027 deadline; Medicare Advantage 72-hour prior auth clock; why medical claim denials are rising.
Last reviewed: