Services
Revenue cycle workflows engineered for post-acute care
From intake and eligibility to payment posting and appeals, every workflow is built around the payment model, deadlines, and assessment data of your care setting.
Service lines
Choose your care setting
Each vertical is staffed by specialists who work that payment model every day.
PDGM-precise billing from NOA to final claim.
Under the Patient-Driven Groupings Model, reimbursement depends on what is documented at intake and in the OASIS — not on visit volume. Our home health team pairs certified coders with Medicare billing specialists who work inside your EHR to keep every 30-day period accurate, timely, and defensible on audit.
- NOA submission target
- 1 business day
- Pre-bill audit coverage
- 100% of claims
- Return-to-provider fixes
- Same day
Billing workflow
Intake & eligibility verification
HETS 270/271 checks confirm Part A entitlement, Medicare Advantage enrollment, and any open home health or hospice periods before the start-of-care visit.
- HETS
- MA authorizations
Notice of Admission (NOA)
We submit the NOA as soon as the start-of-care visit and initial orders are documented, then confirm acceptance in FISS — well inside the 5-calendar-day window that triggers late-NOA payment reductions.
- TOB 032A
- 5-day rule
OASIS & coding review
Certified coders validate the primary diagnosis and comorbidities, and flag OASIS functional items that conflict with clinical documentation for clinician review before the assessment is locked and submitted to iQIES.
- ICD-10-CM
- OASIS
- iQIES
Orders, face-to-face & plan of care
Face-to-face encounter documentation, signed plans of care, and interim orders are tracked against the certification timeline so no claim is held — or billed — without them.
- F2F
- Plan of care
Visit reconciliation & LUPA monitoring
Scheduled and completed visits are reconciled weekly against each period's LUPA threshold, so clinical managers can act while the period is still open.
- LUPA thresholds
- Visit audits
Final claim & payment posting
Final claims carrying the correct HIPPS code are released after a 100% pre-bill scrub; 835 remittances are auto-posted and every variance is worked to resolution.
- TOB 0329
- HIPPS
- 835 ERA
What we manage
- PDGM period grouping and HIPPS validation
- NOA timeliness monitoring and exception requests
- OASIS-to-claim consistency checks
- Review Choice Demonstration (RCD) pre-claim review submissions
- Medicare Advantage and Medicaid authorization tracking
- ADR and Targeted Probe & Educate (TPE) response packages
- Aged A/R recovery and write-off prevention
- Monthly case-mix, LUPA, and denial trend reporting
Denial triggers we prevent
Late NOANOA accepted after the 5-calendar-day window reduces period payment
Prevention: Same-day start-of-care alerts and FISS acceptance checks
CARC 16Claim lacks information or has submission or billing errors
Prevention: Payer-specific scrubber edits before every submission
CARC 50Services not deemed medically necessary
Prevention: Homebound status and skilled-need documentation review
OASIS matchNo accepted OASIS assessment supports the billed period
Prevention: iQIES submission reconciliation before final claims
Election-to-discharge compliance for every benefit period.
Hospice reimbursement is won or lost on timeliness and eligibility documentation. A late NOE turns covered days into provider liability, a missed face-to-face encounter halts payment for the benefit period, and an unmanaged cap can claw back a year of revenue. We track each of these on a daily cadence.
- NOE filing target
- Same day
- Benefit-period tracking
- Every patient
- Cap projections
- Monthly
Billing workflow
Referral & benefit-period verification
Eligibility checks surface prior hospice elections, so the correct benefit period, routine home care day count, and face-to-face requirements are known on day one.
- HETS
- Benefit periods
Election statement review
Election statements are checked for every required element, including the attending physician designation and the patient's right to request the addendum of non-covered items.
- Election
- Addendum
Notice of Election (NOE)
NOEs are filed and confirmed as accepted within 5 calendar days of the election date. Any late days are identified immediately, with exception documentation prepared when circumstances qualify.
- TOB 8XA
- 5-day rule
CTI, recertification & face-to-face tracking
Certifications, narratives, and signatures are tracked for every 90- and 60-day benefit period, with face-to-face encounters completed within 30 days before the third and each later period.
- CTI
- F2F
Monthly claims & level-of-care billing
Routine home care (days 1–60 and 61+), continuous home care, inpatient respite, and general inpatient days are billed with complete visit detail and validated service intensity add-on eligibility.
- Rev codes 0651–0656
- SIA
Discharge, NOTR & cap management
Live discharges and revocations trigger an NOTR within 5 calendar days, and aggregate and inpatient cap exposure is projected monthly — not discovered at year-end.
- TOB 8XB
- Hospice cap
What we manage
- Tiered routine home care and SIA billing validation
- NOE/NOTR submission with FISS acceptance monitoring
- CTI, recertification, and face-to-face compliance tracking
- Aggregate and inpatient cap projections
- Room-and-board billing for dual-eligible nursing facility residents
- PEPPER analysis for live discharges and long lengths of stay
- ADR, TPE, and UPIC audit response support
- Hospice Quality Reporting Program deadline tracking
Denial triggers we prevent
Late NOEDays before NOE acceptance become provider liability
Prevention: Same-day filing with daily acceptance checks
Missing F2FNo timely face-to-face encounter for the third or later benefit period
Prevention: Benefit-period calendars with 30-day advance scheduling
CARC 50Terminal prognosis not supported by the documentation
Prevention: CTI narrative and clinical decline-indicator review
CARC 18Exact duplicate claim or overlapping billing period
Prevention: Claim-history checks before submission
PDPM accuracy from MDS to monthly claim.
Under PDPM, five case-mix components are set by the MDS — so every coding and scheduling decision flows straight to the per-diem rate. We connect MDS coordinators, therapy, nursing, and the business office through a structured triple check so Part A, Part B, Medicare Advantage, and Medicaid claims reflect the acuity you actually deliver.
- Triple-check coverage
- Every Part A claim
- MDS-to-claim reconciliation
- Every cycle
- Consolidated billing review
- Monthly
Billing workflow
Pre-admission verification
We confirm the qualifying 3-day inpatient stay, remaining SNF benefit days, and Medicare Advantage authorization requirements before the resident arrives.
- 3-day stay
- Benefit days
MDS scheduling & ARD coordination
5-day assessment reference dates are set within days 1–8, and interim payment assessments are flagged when documented clinical changes warrant them.
- 5-day PPS
- IPA
PDPM coding validation
The primary diagnosis in I0020B, Section GG functional scores, SLP comorbidities, and NTA conditions are validated against the medical record.
- I0020B
- Section GG
- NTA
Triple check
MDS data, physician orders, therapy minutes, and the UB-04 are reconciled line by line before each monthly Part A claim is released.
- MDS
- UB-04
Claims submission & variable per diem
Part A claims carry the correct HIPPS codes and interrupted-stay logic, with PT, OT, and NTA variable per diem schedules validated for every day billed.
- TOB 021X
- Rev code 0022
Consolidated billing & ancillary reconciliation
Outside vendor charges for labs, imaging, pharmacy, and therapy are reconciled against consolidated billing exclusions, and Part B, Medicare Advantage, and Medicaid claims are worked through to payment.
- Consolidated billing
- Part B
What we manage
- PDPM case-mix accuracy reviews
- MDS ARD scheduling and IPA monitoring
- Structured triple-check workflows
- Consolidated billing vendor reconciliation
- NOMNC and SNF ABN liability notice tracking
- Medicare Advantage authorization and concurrent review support
- Medicaid eligibility and pending-application follow-up
- Part B therapy and ancillary billing
Denial triggers we prevent
Late MDSA late 5-day assessment pays the default rate until its ARD
Prevention: ARD calendar alerts for every admission
CARC 96Non-covered charges, such as a stay without a qualifying hospitalization
Prevention: 3-day stay and benefit-day verification at admission
CARC 197Precertification or authorization absent
Prevention: Medicare Advantage authorization tracking with renewal alerts
CB editsOutside supplier claims rejected under consolidated billing
Prevention: Monthly vendor invoice reconciliation
Denial management
A closed loop that makes every denial less likely than the last
Denials are symptoms. We work them fast and then remove the cause — so your denial rate trends down month after month instead of resetting every cycle.
Prevent
Payer-specific scrubbing plus eligibility, authorization, and documentation checks run before any claim is released.
Detect
999, 277CA, FISS status, and 835 data are parsed daily, so rejections and denials surface within hours — not at month-end.
Correct
Every denial is root-caused, then corrected and resubmitted or appealed within 48 hours, with redetermination deadlines tracked.
Learn
Denial trends feed back to intake, clinical, and MDS teams in a monthly prevention report that closes the loop.
Redetermination, reconsideration, and ALJ deadlines are calendared for every appealed claim.
Clearinghouse management
Every claim tracked from 837I to 835
We monitor each handoff between your EHR, clearinghouse, Medicare FISS, and commercial payers, so rejections are fixed in hours and payments reconcile to the penny.
837I institutional claims
Home health, hospice, and SNF claims formatted to X12 5010 and each payer's companion guide.
FISS / DDE claim management
Direct correction of Medicare Part A claims in return-to-provider status, plus daily suspense monitoring.
Acknowledgment tracking
999 and 277CA acknowledgments reconciled against every batch, so no claim disappears between systems.
835 ERA auto-posting
Remittances posted automatically with CARC/RARC-level variance review and EFT deposit reconciliation.
BAA signed before we review a single claim
Not sure which workflows are costing you the most?
Start with a free RCM audit. We'll review a sample of claims, denials, and aged A/R, then show you where timeliness, coding, and documentation gaps are costing revenue.