Specialty
Home health billing services
Home health billing services get a Medicare-certified agency paid for each 30-day period of care.
See where claims are getting stuck. No patient data needed.
The order of events is fixed: a Notice of Admission accepted by the contractor within five calendar days of admission, an OASIS assessment accepted before the claim, a plan of care and every verbal order signed, a HIPPS code that matches the assessment, each visit on its own revenue code line, and the period claim released when the 30 days end or the patient is discharged, whichever comes first. Remitwright gives agencies a dedicated biller who tracks every admission against those dates, corrects every returned claim, and reads each denial back to the gate that failed.
Home health billing is one of Remitwright's specialty billing services, each set out with its own code families, denial reasons and payer rules.
Last reviewed by the Remitwright billing team. Editorial policy
- 0023
- 032A
- 027
Denials
Why home health claims get denied
The reasons that come up most on home health remittances, with the usual cause and the fix. Code explanations are our own; the official list is maintained by X12.
| Code | Reason | Usual cause | The fix |
|---|---|---|---|
| CO-16 | Claim data missing or wrong | The HIPPS code on the 0023 line does not match the accepted OASIS, a visit line is missing its G-code, or the admission date does not agree with the Notice of Admission | Claim edits that compare the HIPPS code to the accepted assessment and require a HCPCS code on every visit line before release |
| CO-50 | Not medically necessary | Homebound status or the skilled need is not supported in the record, or the face-to-face encounter is missing, unrelated to the reason for home care, or outside its window | The encounter date, its relation to the primary diagnosis and both homebound criteria checked at admission, before the Notice of Admission goes out |
| CO-18 | Duplicate or overlapping period | Another agency still has an open admission for the patient, a hospice election is on file, or a transfer was billed without patient discharge status 06 | An eligibility check for open home health and hospice episodes before the first visit, and transfers coded as transfers on both agencies' claims |
| CO-97 | Bundled to the agency's period payment | An outside therapist or supplier billed Medicare directly for a patient under your plan of care, when consolidated billing pays your agency for those services whoever furnished them | The admission list shared with every contracted provider, and services furnished under arrangement captured on your period claim |
| CO-29 | Sent after the filing deadline | Period claims held for an unsigned order or an unaccepted OASIS until the Medicare filing limit passed, with nobody chasing the signature | A held-claims list with the reason, the owner and the filing deadline for each hold, and signatures escalated before the claim ages out |
Codes
Common home health codes and modifiers
Code families by number with our own one-line explanations. CPT descriptors belong to the AMA and are not reproduced here.
| Codes | What the codes cover |
|---|---|
| Revenue code 0023 with a HIPPS code | The one payment line on every period claim. The five-character code carries the referral source and period timing in the first position, the clinical group in the second, the functional level in the third, the comorbidity level in the fourth, while the fifth holds no grouping value. |
| Type of bill 032A, 0329, 0327, 0328 | The Notice of Admission, the period claim, an adjustment and a cancellation. The type of bill is how the home health and hospice contractor knows what it is looking at. |
| 027x and 0623 | Nonroutine medical and surgical supplies, and the wound care supplies an agency chooses to identify on their own line. Both sit inside the period payment and are not paid on top of it. |
| 042x, 043x, 044x with G0151-G0153, G0157-G0161 | Physical therapy, occupational therapy and speech-language pathology visits, by therapist or assistant and by whether the visit was treatment, assessment or a maintenance program. |
| 056x and 057x with G0155 and G0156 | Medical social service visits and home health aide visits, each reported as a separate line with its own units. |
| 055x with G0162, G0299, G0300, G0493-G0496 | Skilled nursing visits, split by whether a registered nurse or a licensed practical nurse made the visit and whether it was direct care, observation and assessment, teaching, or management and evaluation of the plan. |
| Type of bill 034x | Osteoporosis drugs and disposable negative pressure wound therapy, which are billed on their own claim even while an admission period is open. |
Claim codes and fields that matter
- Patient discharge status 06
- Not a modifier but the field that drives payment. Report it when a patient transfers to another agency or is discharged and readmitted inside the same 30 days; the contractor then prorates the period by billable days divided by 30.
- Admission date equal to the From date
- On the first period of an admission. The LUPA add-on pays only when the two dates match, and a wrong admission date on a later period can pull the add-on onto the wrong claim or get the claim returned.
- Condition code 21
- On a LUPA claim the contractor returned because it had no qualifying skilled visit, when the visit really was not made and the agency is billing to obtain a denial notice rather than adding a visit.
Payers
Payer notes
- MedicareThe Notice of Admission is timely when it is submitted to and accepted by the home health and hospice contractor within five calendar days after the admission date. When it is late, payment for the period, including any outlier payment, is reduced by the number of days from admission to acceptance divided by 30, no per-visit LUPA payments are made for visits before the notice, and the reduction is the agency's liability, not the patient's. Four kinds of exception can be requested, including disasters, contractor system problems and a newly certified agency awaiting its user ID.1
- MedicarePayment is a national, standardized rate for each 30-day period of care, in force since January 1, 2020, and periods are placed in one of 432 case-mix groups built from admission source, period timing, clinical grouping, comorbidity adjustment and the functional impairment level derived from OASIS.2
- MedicareThe CY 2026 final rule set a 2.4 percent payment update offset by a permanent adjustment of -1.023 percent and a temporary adjustment of -3.0 percent, an aggregate decrease CMS estimated at 1.3 percent or 220 million dollars. The same rule recalibrated the case-mix weights and the LUPA thresholds using CY 2024 data and allowed physicians, in addition to nurse practitioners, clinical nurse specialists and physician assistants, to perform the face-to-face encounter regardless of who certifies.3
- MedicareThe face-to-face encounter must occur no more than 90 days before or within 30 days after the start of care, and a patient is homebound only when a listed condition is present and there is both a normal inability to leave home and a considerable and taxing effort when leaving. Each 60-day certification covers two 30-day payment periods, with the recertification assessment due in the last five days of the certification period.4
- MedicareUnder the Review Choice Demonstration in Illinois, Ohio, Texas, North Carolina, Florida and Oklahoma, agencies choose pre-claim review or postpayment review. The minimal review choice with a payment reduction was removed from the initial options on June 1, 2024, when the demonstration was extended for five more years.5
Authorizations
Original Medicare has no prior authorization for home health, but in the six Review Choice Demonstration states every period goes through pre-claim review before the claim or postpayment review after it, and the agency's affirmation rate decides how much review it faces. Everywhere else the gates are the certification, the face-to-face encounter, the signed plan of care and the accepted OASIS. Medicare Advantage plans run their own authorizations, usually by discipline and visit count, and state Medicaid programs set their own authorization and visit verification rules for the home health they cover. Your biller keeps one tracker per admission with the review choice, the authorization numbers and the dates each gate was met.
Documentation traps
- The OASIS submitted but not yet accepted when the claim is released, so the HIPPS code cannot be validated and the claim is returned
- A verbal order still unsigned at claim time, which the manual does not allow, so the claim has to wait and the clock keeps running
- A face-to-face encounter dated outside the 90-days-before or 30-days-after window, or one that does not address the reason the patient needs home care
- A homebound narrative that lists the diagnosis but never describes the taxing effort it takes the patient to leave the house
- Visits made but never entered, so the period falls under the LUPA threshold on paper and pays per visit
- The admission date keyed differently on the notice and the claim, which misplaces the LUPA add-on and sends the claim back
What a specialist checks
Specialist or generalist for home health billing?
A generalist biller can enter a home health claim. Whether it pays turns on three things specific to home health billing, and a specialty-aware biller checks each one.
Billing codes
Each code reported with what the record has to show for it.
- Revenue code 0023 with a HIPPS code
- Type of bill 032A, 0329, 0327, 0328
- 027x and 0623
Claim codes and fields
Each one reported only where the record supports it.
- Patient discharge status 06
- Admission date equal to the From date
- Condition code 21
If you are moving from another billing company or an in-house biller, switching billing companies follows a plan: the old and new processes run side by side until the new one is proven, and every login and every home health claim stays in your name.
What we handle
What we handle for home health agencies
- Eligibility verificationCoverage and benefits checked before visits
- Claim submissionScrubbed, submitted and tracked to acceptance
- Payment postingERAs and EOBs posted, variances flagged
- Denial managementEvery denial read, worked and appealed
- A/R follow-upUnpaid claims chased before filing limits
- Billing reportingWeekly reports you can actually read
A dedicated biller with named cover, working inside your system and reporting to you on one written page. How it works sets out the five stages.
Software
Systems home health agencies usually run
- WellSky
- Axxess
- Homecare Homebase
- MatrixCare
- Netsmart
Your biller works inside your system as a user you create. All the systems we work in.
Questions
Questions about home health billing
How late can a Notice of Admission be before it costs the agency money?
What is the HIPPS code on a home health claim?
When can the period claim go out?
What is a LUPA and how do we keep one from surprising us?
Which states have the Review Choice Demonstration and what do we choose?
Where do PDGM and the rest of home care billing fit?
A contracted therapy company billed Medicare during our period. Now what?
How do we move billing to Remitwright without missing a period?
Next step
See where your home health claims are getting stuck.
Three quick questions. No patient data. A billing specialist reads every request and replies in writing.
- Three questions, about two minutes
- No patient data, no software to buy
- A written reply from a biller, not a sales deck
You answer three questions
A billing specialist reads them
A written reply by email
Prefer email? sales@remitwright.com
Request received
Thanks. Your review request is in.
Reference . Quote it if you write to us about this request.
- A billing specialist reads your answers and replies by email.
- If a look at real claims makes sense, we agree read-only access under a BAA first.
- You get a written summary of what is worth working and what it would take. No commitment.
While you wait: see the sample weekly report or read the home care billing guide. You can also download the sample weekly report (PDF).