Tuesday, January 17, 2012

Tips on Avoiding Common Medicare Home Health Billing Errors!

Today's Home health care billing is more critical than ever.

Shrinking reimbursement and increased regulations are forcing agencies to optimize their billing process. With many layers of complexity in the billing process, agencies have found that even a small number of billing errors have resulted in significant payment losses. Understanding the common home health billing errors and how to avoid them can significantly increase your profitability.

Here are some tips on common Medicare home health billing errors you can avoid:

1. Incorrect patient information- Inaccurate patient information will cause claim rejections or RTP claims. Incorrect patient address, zip codes, names and policy numbers are common and avoidable mistakes. Be sure your biller double check patient demographics to avoid payment delays.

2. Incorrect source of admission- Determining whether a patient is being referred to your agency by a "physician referral" or "transferred" from another agency is one of the most misunderstood billing errors. Source of admission is determined by reviewing the patient's eligibility documentation and must be accurately identifying on the claim. Be sure your billers understand source of admission to avoid payment delays.

3. Invalid diagnosis codes- Do not use codes that are marked "invalid". Every October new diagnosis codes are published. Be sure your billers are keeping up to date to avoid payment delays.

4. Incorrect or missing physician NPI- The physician's full name and NPI must be entered on a claim correctly. Be sure your biller double check this information to avoid payment delays. The financial strength of your agency is directly correlated to timely billing and skilled billers. Use these tips and keep your eye on minimizing your rejected claims to maximize your productivity and provide you with a steady cash flow.

5. Overlapping visits with another provider- Be sure to check your Medicare eligibility to verify the discharge date from another agency. Be sure your Start of Care does not overlap with the previous provider, admit the patient after the discharge date of the other provider. This will ensure you are not overlapping dates with the other agency and will not cause the claim to be rejected.

6- Overlapping with hospice provider- A home health agency can see a patient who is under hospice care. Be sure your biller know the special billing requirements that must be met in order to avoid a rejected claim. Add the appropriate condition codes to claim to get it paid.


  1. I appreciate the ideas and I would like to read more good stuff keep it up! This is very nice article and have great information

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  2. Hey thanks for such helpful and knowledgeable tips.Many hospitals are cheat people by keeping some or the other error and increase the bills to higher rates which is not at all good.

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