Phone: (614) 407-1113

Home Health Care Billing

Home Health Care Billing

Home Health Care Billing is the lifeblood of your agency. Complete Revenue Solutions was founded on the principal that without excellent home health billing, your agency cannot survive or thrive. As former home care executives, Complete Revenue Solutions understands how a single denial can change the financial health of your business. CRS believes that home health care is one of the most important parts of healthcare and understands the importance of home health billing to an agencies success.

Home Health Care Billing: Medicare Claims

Over the past 20 years, home care billing for Medicare patients has changed dramatically. It is no longer sufficient to just submit claims and sit back waiting for payment. Our process focuses on superior attention to detail and consistent, reliable follow-up.

RAP Clams:

  • Medicare designed the RAP Payment for Home Health billing as a way for providers to make cash flow more predictable and sustainable
  • RAP stands for Request for Anticipated Payment. Home Health Care providers submit RAP claims to obtain 50-60% of the anticipated payment for an episode at the beginning of a patient’s care episode. This payment is determined based on the codes generated by the Home Health Agencies OASIS assessment
  • Industry standards suggest RAP Claims should be billed within 7 days of the episode start date

Complete Revenue Solutions: RAP Billing Standards

  • RAP Claims for Home Health Care Billing are submitted within 24 hours of an agency’s OASIS lock date. This means as soon as an agency completes an OASIS and it is approved by the agency’s Quality Assurance (QA), CRS submits the RAP claim within 24 hours
  • Home Health RAP’s are paid on average 5-7 days after submission by the CRS team
  • Denials are elevated to our troubleshooting department within 24 hours of T or R status being reflected by Medicare. Denials are corrected and resubmitted within 48 hours.
  • If a RAP claim remains unbillable due to an incomplete OASIS after 7 days of episode start date, Home Health Agency is notified and CRS Troubleshooting team will work with the agency until the RAP claim is billable

End of Episode or Final Claim Billing:

  • End of Episode (EOE Claims) are submitted to Medicare for the payment of the entire episode.
  • Medicare pays the entire amount and recoups the RAP payment
  • Industry standards suggest EOE Claims should be billed within 14 days of the episode end date

Complete Revenue Solutions: EOE Billing Standards

  • Home Care EOE Claims are reviewed and submitted within 24 hours of completion of all required documentation for an episode by the Home Health Agency
  • Home Health Billing success is dependent on successful RAP and EOE billing, CRS analyzes all episodes to insure effective billing practices
  • Home Care EOE claims are paid on average 10-14 days after submission by the CRS team
  • 96% of CRS claims are paid within this time frame, any claim that is not is forwarded to the troubleshooting team and followed up on daily for denial management

Home Health Billing Process: Medicaid Claims

Home health billing for state Medicaid plans is completed based on the agency’s state requirements. Majority of states reimburse for home health on a per visit basis. These claims are billed weekly by CRS unless otherwise requested by a provider. Complete Revenue Solutions will provide each agency with a personalized claims strategy based on that agencies state requirements and company policies.

Home Care Billing Process: Commercial Insurance Billing

Home care billing for commercial insurance plans varies from company to company. CRS can utilize electronic claims submission via UB-92, UB-04, HCFA 1500, and all other claims forms. For any insurance company that does not accept these forms, CRS can create the proper forms and submit claims via electronic or mail submission.

The CRS Difference:

Complete Revenue Solutions believes the key to success in home health care billing is unrelenting attention to detail and constant follow-up. CRS guarantees all claims will be submitted within the agency determined time frames and has an industry leading 96% first attempt payment rate. As a home health agency, you face increasing challenges every single day; CRS promises your billing will no longer be one of those!

For More information about Home Health Care Billing, visit the CMS Claims Processing Manual

Complete the form below for a free analysis and free billing trial!

Home Health Care Billing

Carter Smith

President & CEO

Phone: (614) 407-1113