Home Health Billing Services

We offer flexible pricing based on your agency’s needs. Our most common model is percentage-based, where we charge a fair percentage of the revenue we help you collect. This aligns our success with yours and covers all essential services like PDGM billing, NOA filing, denial management, and A/R follow-up.

In 2026, CMS updated how each 30-day billing period (called an episode) is classified into one of 432 clinical groups. These groups are based on the patient’s main diagnosis (using ICD-10 codes), their level of functional ability, and other health conditions (comorbidities). This recalibration changes how much your agency is paid, so accurate coding and documentation are essential to receive full payment.

Functional scoring measures a patient’s ability to perform daily activities and is captured through the OASIS-E1 assessment. This score affects the “case-mix weight” — basically, how complex or resource-intensive a patient’s care is considered. A higher functional impairment score means the agency gets reimbursed more for the care provided during that 30-day episode.

LUPA stands for Low Utilization Payment Adjustment. It’s a reduced payment that applies if a patient receives fewer therapy visits than CMS’s set minimum threshold. In 2026, these minimum visit numbers (thresholds) have changed depending on the patient’s clinical group. If therapy visits fall below these new thresholds, the agency gets paid less. We use accurate tracking and documentation of therapy visits to help avoid losing revenue due to LUPA penalties.

OASIS-E1 adds new questions about social factors that affect health (Social Determinants of Health or SDOH), such as living conditions or access to transportation. It also changes how some answers translate into billing codes, which can affect how Medicare calculates payments. Our AAPC-certified team properly documents and codes these new items to avoid penalties and ensure accurate reimbursement.

NOA means Notice of Admission. CMS requires that this notice be submitted electronically within one calendar day of a patient’s admission to your agency. If it’s late or missing, Medicare will not pay for the services during that episode, which results in lost revenue and claim denials. BilRex utilizes automated tracking tools and adheres strictly to submission rules to avoid this costly mistake.

Comorbidities are additional health conditions a patient has alongside their primary diagnosis. CMS recognizes that patients with more or more severe comorbidities require more care, so it increases payments through comorbidity adjustments. If your coding accurately captures these secondary diagnoses, your agency could see up to a 20% increase in reimbursement per episode.

Our AI-driven tools check claims for errors before submission, catching issues that often cause denials. This means over 98.5% of claims are clean on the first try, denial rates stay below 1.2%, and payments come in faster without extra work.