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AI-Powered Revenue Optimization

Smarter Billing for Home Health Agencies — Powered by AI, Driven by Results

Home health billing is complex, time-consuming, and highly sensitive to errors—but our AI-powered Home Health Medical Billing solution turns it into a streamlined, revenue-focused process. We use intelligent automation to improve coding accuracy, prevent denials, accelerate claim submissions, and provide real-time visibility into your financial performance. With proactive compliance monitoring and expert oversight, your agency can reduce administrative workload, improve cash flow, and focus more on delivering quality patient care while we drive consistent, measurable results.

 
 
  • Trusted by hospitals, home health specialist and home health groups nationwide
  • HIPAA-compliant + Fully U.S.-based billing oversight
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What Makes Home Health Billing So Challenging?

Home health billing is complex due to strict documentation, PDGM requirements, and varying payer rules—making accuracy and compliance critical to prevent denials and revenue delays.

 

PDGM Coding & Claims Preparation

We ensure accurate PDGM classification, coding, and claim preparation based on clinical data and OASIS assessments to maximize reimbursement and reduce payment errors.

OASIS Accuracy & Timely Submission

OASIS data directly impacts case-mix calculation and reimbursement. Errors, inconsistencies, or late submissions can lead to payment delays, rejections, or compliance risks.

LUPA Threshold Management

If visit utilization falls below payer-defined thresholds, agencies receive Low Utilization Payment Adjustments (LUPA), resulting in reduced reimbursement. Poor visit tracking increases revenue loss risk.

Strict Face-to-Face & Documentation Requirements

Medicare requires valid face-to-face encounters, physician orders, and detailed clinical documentation. Missing or incomplete records often lead to denials or audit exposure.

Eligibility, Authorization & Certification Cycles

Home health services require ongoing eligibility checks, prior authorizations (for some payers), and timely physician certifications and recertifications. Missed timelines can result in non-billable services.

Payer-Specific Billing & Compliance Variations

Medicare, Medicaid, and commercial insurers each have different billing rules, submission formats, and documentation standards, increasing administrative workload and denial risk.

Due to billing complexity, home health agencies partner with experts to improve cash flow and reduce denials.

Our Services

Smarter Revenue Management for Home Health Providers

Streamline claims and strengthen financial performance.

PDGM Coding & Claims Preparation

We ensure accurate PDGM classification, coding, and claim preparation based on clinical data and OASIS assessments to maximize reimbursement and reduce payment errors.

OASIS Review & Documentation Validation

Our team reviews OASIS data, physician orders, and clinical documentation to ensure accuracy, completeness, and compliance with Medicare requirements.

Eligibility, Authorization & Certification Management

We verify patient eligibility, manage prior authorizations when required, and track physician certifications and recertifications to prevent billing delays.

Claims Submission & Payment Tracking

We submit claims promptly, monitor their status through payment, and resolve rejections, denials, and resubmissions to accelerate reimbursements.

Accounts Receivable (AR) & Denial Management

Our team proactively follows up on unpaid claims, resolves denials quickly, and reduces days in A/R to maintain steady cash flow.

Compliance, Reporting & Revenue Insights

Receive detailed reports on claim performance, denials, collections, and financial trends while we ensure ongoing compliance with Medicare, HIPAA, and payer guidelines.

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Our Services

Better Billing Performance Backed by Data

Increase in Net Collections
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First-Pass Clean Claim Rate
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Reduction in AR Days
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I have been using 5 Star Billing Services, Inc. for over two years now. I am impressed with the detail and thoroughness that they consistently demonstrate. The team assigned to us is very familiar with the coding necessary for our specialty (chronic pain), and they excel at preventing rejections.

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Gary L. Child, D.O.

Medical Director

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Our Process

A Smarter Workflow Built for Home Health

Our AI-Enhanced Billing Process

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Data Intake & Verification

Seamless integration with your EHR, practice management, and home health documentation systems for efficient and accurate data flow.

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AI-Assisted Coding + Expert Review

AI-driven machine learning validates coding accuracy, while certified billing specialists review and ensure full compliance with payer and regulatory requirements.

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Claim Submission With Automated Follow-Up

Clean claims are submitted promptly with AI-enabled tracking and proactive follow-ups to accelerate payments and reduce delays.

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Payment Posting + Revenue Insights

Access a real-time dashboard with actionable insights on collections, denials, A/R, and payer trends—empowering smarter decisions and driving practice growth.

Continuous Expert Oversight

Every step monitored by senior billing analysts specializing in home health

Seamless EHR & Home Health Software Integration​

No workflow disruptions. Our team adapts to your clinical system and billing tools, supporting efficiency from day one.

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Commonly Used  CPT and ICD Codes in Home Health

Home Health CPT Codes

Skilled Nursing & Therapy Services

G0299 – Skilled nursing visit (RN) in home health setting

G0300 – Skilled nursing visit (LPN/LVN)

G0151 – Physical therapy visit

G0152 – Occupational therapy visit

G0153 – Speech-language pathology visit

G0155 – Clinical social worker visit

G0156 – Home health aide services

Additional Home Health Services

G0160 – Occupational therapy evaluation

G0161 – Physical therapy evaluation

G0162 – Skilled nursing services for management and evaluation of care plan

Chronic Conditions

  • I10 – Essential (primary) hypertension

  • E11.9 – Type 2 diabetes without complications

  • I50.9 – Heart failure, unspecified

  • J44.9 – COPD, unspecified

Post-Surgical / Aftercare

  • Z48.01 – Encounter for change/removal of surgical wound dressing

  • Z47.1 – Aftercare following joint replacement

  • Z48.815 – Aftercare following surgery of digestive system

Mobility & Functional Limitations

  • R26.89 – Other abnormalities of gait and mobility

  • Z74.09 – Other reduced mobility

  • M62.81 – Muscle weakness (generalized)

Wound Care

  • L89.90 – Pressure ulcer, unspecified site

  • S81.809A – Open wound of lower leg

Why Home Health Providers Trust 5 Star Billing Services

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AI-powered claim validation improves PDGM accuracy and reduces errors, denials, and payment delays.

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Certified home health coding specialists ensure accurate OASIS alignment and full Medicare compliance.

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End-to-end revenue cycle management strengthens collections and maintains consistent cash flow.

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Proactive AR follow-ups and denial resolution accelerate reimbursements and reduce aging claims.

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Real-time reporting and analytics provide complete visibility into your home health financial performance.

Frequently Asked Questions

Home health billing is more complex due to PDGM payment rules, OASIS-based reimbursement, physician certification requirements, and strict Medicare documentation standards. Accurate coding, timely submissions, and compliance management are essential to avoid denials and payment delays.

The Patient-Driven Groupings Model (PDGM) determines payment based on clinical grouping, functional level, admission source, timing, and comorbidities. Incorrect coding or OASIS data can lower reimbursement or trigger claim adjustments, making accuracy critical.

Specialized billing services improve claim accuracy through eligibility verification, OASIS and documentation review, PDGM validation, and payer rule checks. Proactive denial management and timely follow-ups help recover revenue and reduce days in A/R.

Yes. Our home health billing services manage claims for Medicare, Medicaid, and commercial payers, ensuring compliance with each payer’s specific guidelines, documentation requirements, and submission processes.

You receive detailed reports on clean claim rates, denials, collections, days in A/R, and outstanding balances. These insights provide full visibility into revenue performance and help identify opportunities to improve cash flow.

Smarter Home Health Billing, Better Results

Benefits of Outsourcing Home Health Medical Billing

 

Faster and More Accurate Reimbursements

Accurate PDGM classification, OASIS validation, and clean claim submission help reduce errors, minimize rejections, and speed up payment cycles.

Reduced Denials and Revenue Loss

Proactive claim reviews, documentation checks, and payer-specific validation prevent common issues that lead to denials and underpayments.

mproved Cash Flow and Lower Days in A/R

Timely submissions, continuous payment tracking, and consistent follow-ups ensure faster collections and stronger financial stability.

Full Compliance with Medicare and Payer Rules

Stay compliant with changing PDGM guidelines, documentation standards, HIPAA requirements, and payer-specific policies to reduce audit risk.

Less Administrative Burden for Your Team

Outsourcing billing tasks frees your staff from complex revenue cycle work, allowing them to focus more on patient care and operations.

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Our Tailored Home Health Billing Service is ideal for

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Solo home health specialist in private practice

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Multi-specialty group practices that offer home Health services

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Surgical centers, hospital units, and ambulatory surgical centers (ASCs)

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Practices operating across multiple states or with complex payer mixes

AI-powered anesthesia coding services

AI-Powered Compliance & Precision: Why 5 Star Billing Leads in home Health

  • Proven expertise in medical billing and revenue cycle management across 40+ healthcare specialties.
  • Certified home health coding specialists trained in psychotherapy, psychiatry, and payer-specific compliance requirements.
  • AI-powered workflows that improve coding accuracy, reduce denials, and accelerate reimbursements.
  • Nationwide support for providers in all 50 U.S. states, regardless of location or payer mix.
  • A results-driven approach focused on compliance, clean claims, and maximizing your practice’s financial performance.

Simplify Your Home Health Billing Today

Contact us today to learn how we can tailor our Home Health Billing Service — across any state.

Contact Information

Phone

+1-480-999-0180

Email

info@drbillingservice.com

Service Area

Nationwide Service

CPC Certificate
HIPAA certificate
BBB A+-01

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