PDGM period classification
Each 30-day period is grouped by admission source, timing, clinical grouping and functional level from the OASIS. Coding that drives the wrong group under-reimburses the entire period.
Specialties › Home Health & Hospice
Home Health & Hospice Billing Services
Home health and hospice are billed on episodes and notices, not visits — and the deadlines are unforgiving. A late Notice of Admission reduces payment for every day it was late. PDGM classifies each 30-day period into a payment group from the OASIS and diagnosis coding. Hospice pays a daily rate that changes with the level of care. Practices that bill this like an office lose real money to timing alone.
What makes it hard
Home Health & Hospice billing challenges we solve
These are the issues that repeat every month in home health & hospice practices — and the ones we fix at the source rather than reworking claim by claim.
Notice of Admission timing
The NOA must be submitted within the required window. Late submission permanently reduces payment for the days it was late — a pure, avoidable loss.
OASIS accuracy
The OASIS assessment drives both payment and quality scores. Errors flow straight into the payment group and are difficult to correct after billing.
Hospice levels of care and election
Routine home care, continuous home care, inpatient respite and general inpatient each pay a different daily rate, and the hospice election and benefit periods must be maintained correctly.
Face-to-face and certification
Home health and hospice both require timely face-to-face encounters and physician certification. Missing or late certification denies otherwise covered care.
Coding depth
What home health / hospice billing involves
- PDGM 30-day period grouping from OASIS and diagnosis coding
- Notice of Admission (NOA) timely submission
- OASIS assessment review for payment accuracy
- Hospice daily rates by level of care (routine, continuous, respite, GIP)
- Hospice election, benefit periods and recertification
- Face-to-face encounter and physician certification tracking
- Value-based and quality reporting interactions
Listed for context only — this is not billing advice, and payer policy varies. Our certified coders work to AAPC and AHIMA standards.
Denial prevention
Top denial drivers in home health & hospice
- Notice of Admission submitted late
- Period grouped incorrectly from OASIS or diagnosis coding
- Missing or untimely physician certification
- Face-to-face encounter not documented in the required window
- Hospice level of care not supported by documentation
We root-cause denials by payer and procedure, then fix the upstream workflow so the same denial stops recurring.
Why ERG
What you get with ERG
Specialty-trained billers
Your account is worked by people who bill home health & hospice every day — not a general pool learning your rules on your claims.
95%+ net collection rate
Relentless follow-up on every claim, with aged A/R worked rather than written off.
No long-term contract
Performance-based pricing — a percentage of what we collect. Stay because the results are good, not because you are locked in.
5–10 day onboarding
We run parallel with your current process until the transition is verifiably clean.
Human-led, AI-supported
Our certified coders work every claim; AI tools help them catch more before submission.
HIPAA-compliant throughout
Strict PHI controls, access limits and staff training across the whole workflow.
FAQ
Home Health & Hospice billing — common questions
Do you understand PDGM?
Yes. Under PDGM each 30-day period is classified into a payment group, and the OASIS plus diagnosis coding drive that classification. Getting the grouping right is where home health revenue is made, and it is not something general billing handles well.
Can you manage NOA and certification deadlines?
Yes. The Notice of Admission and physician certification are deadline-driven, and lateness permanently costs money. We track those windows so payment is not reduced for purely administrative timing.
Do you bill hospice as well as home health?
Yes. Hospice pays daily by level of care and requires correct election and benefit-period management, which is different from home health episodes. We bill both to their own rules.
Will you review our OASIS-driven payments?
Yes. Our A/R analysis looks at whether periods are grouped to the payment they should command, which is frequently where recoverable home health revenue is sitting.
Client results
What practices say about working with us
★★★★★Our A/R days dropped from 58 to 31 in one quarter. First time in years I actually trust my numbers.
— Sarah M., Practice Manager
★★★★★Denials were killing us. First-pass acceptance went up fast, and they tell us why a claim failed — not just rework it quietly.
— Michael R., Billing Lead
Next step
See what your home health & hospice practice is leaving uncollected
A no-obligation A/R analysis. We review your aging, denial patterns and coding mix, then show you exactly where the recoverable revenue is.
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