Written by specialists who live inside home health billing every day.
Under PDGM, every 30-day period has its own LUPA threshold of 2 to 6 visits. Fall below it and the period pays per-visit instead of the full case-mix amount. Here is how the thresholds work and how agencies protect the revenue LUPAs put at risk.
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The NOA replaced RAPs in 2022 and must be accepted within 5 calendar days of the start of care. Miss the window and Medicare cuts 1/30th of the period payment for every day late. Here is how the NOA works and how to keep every one on time.
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OASIS-E1 took effect January 1, 2025 — CMS removed M0110 and M2200, added the O0350 COVID-19 vaccination item, and dropped Section GG discharge goals. Here is the item-level breakdown and what agencies should do.
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RCD requires home health agencies in six states to choose how their claims are reviewed. A clear breakdown of the three choices, the pre-claim vs postpayment trade-off, and the 90% affirmation threshold that unlocks lighter oversight.
Read nowAI in healthcare uses machine learning to aid diagnosis, documentation, and revenue cycle work today, delivering real benefits alongside bias, privacy, and oversight risks.
Read nowA plain-language taxonomy of the AI model types used in healthcare, what each actually does, and where their real limits and risks lie.
Read nowHow AI powers medical coding and revenue cycle management, its accuracy limits, and why human-in-the-loop coding still wins for home health PDGM.
Read nowHow home health agencies use AI for OASIS QA, PDGM coding support, denial prediction, remote monitoring, and revenue cycle automation — with clinician oversight.
Read nowThe future of AI in healthcare points toward agentic workflows, ambient documentation, and revenue cycle automation, tempered by regulation and trust.
Read nowWhat "homebound" means under Medicare — the two-criteria test, which absences are allowed, and how to document homebound status so home health claims survive audit.
Read nowThe top reasons home health claims are denied — late NOAs, homebound and face-to-face gaps, PDGM/OASIS mismatches, eligibility lapses, and untimely filing — and the pre-submission checks that prevent them.
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CMS-1828-F sets 2026 home health payment down an estimated 1.3%. See the permanent -1.023% and temporary -3.0% PDGM adjustments and how to protect revenue.
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How the CMS-HCC V28 model transition reshapes risk adjustment coding for home health agencies in Medicare Advantage and value-based care — and what to fix.
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How PECOS 2.0 changes Medicare enrollment and revalidation for home health agencies, and why NPPES-PECOS data mismatches now threaten billing privileges.
Read nowA structured framework for deciding whether to outsource your revenue cycle management or build an in-house team — with the key questions every administrator must answer.
Read nowA practical pre-submission checklist to achieve clean claim rates above 95% — covering eligibility, authorization, documentation, coding, and technical claim elements.
Read nowLearn how AI-assisted coding reduces home health claim errors by 40-60%, increases throughput by 25-35%, and embeds compliance checks throughout the coding workflow.
Read nowExplore how AI-augmented outsourcing helps home health agencies reduce costs by 30-40%, improve claim approval rates to 96%, and scale revenue cycle operations efficiently.
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A practical HIPAA compliance guide for home health operations — covering PHI safeguards, BAA requirements, breach response, and audit risk reduction.
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Navigate telehealth billing and documentation requirements for home health agencies — what's covered, how to document, and how to stay compliant as policies continue to evolve.
Read nowDiscover how AI-powered clinical documentation reduces documentation time by 20-30%, improves OASIS accuracy by 15-25 points, and closes the documentation-to-coding gap.
Read nowA comprehensive guide to the Patient-Driven Groupings Model — what drives your case-mix weight, and how to optimize revenue under PDGM.
Read nowThe most frequent OASIS assessment errors that trigger compliance risk and reduce reimbursement — with actionable guidance for prevention and correction.
Read nowProven denial management approaches for home health agencies — from root cause analysis to payer-specific appeal strategies that recover revenue faster.
Read nowProvider credentialing bottlenecks silently drain revenue. Learn how to accelerate enrollment timelines and reduce the revenue gap from new provider lag.
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Navigate the complex billing differences between Medicare Advantage plans and traditional Medicare for home health services — authorization requirements and appeal processes.
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How accurate Hierarchical Condition Category coding improves reimbursement under value-based care models and Medicare Advantage contracts for home health agencies.
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Practical strategies to bring your home health agency's A/R days below 40 — from clean claim submission to automated follow-up and denial prevention workflows.
Read nowYour Home Health Compare star rating affects referral volume and competitive positioning. Learn how OASIS accuracy drives your publicly reported outcomes.
Read nowThe financial and operational metrics that reveal the true health of your home health revenue cycle — with benchmarks and warning signs that demand immediate action.
Read nowPractical strategies for managing prior authorization across Medicare Advantage and commercial payers — cutting approval timelines and preventing authorization-related claim denials.
Read nowA practical guide to accurate wound care coding — pressure ulcers, surgical wounds, diabetic ulcers, and the OASIS items that directly affect your reimbursement.
Read nowA practical guide to the HHVBP model — which measures matter most, how your performance is calculated, and what interventions drive the highest score improvement.
Read nowStay current on ICD-10-CM updates that affect home health coding, PDGM groupings, and reimbursement — the changes that create compliance risk if overlooked.
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