Medical Billing · Nationwide
Home Health & Hospice Care Medical Billing Services
PDGM 30-day billing periods, OASIS-E HIPPS grouping, 5-day Notice of Admission (NOA) filing, and statutory hospice aggregate cap reconciliation.
Aethera Healthcare Solutions provides full-service medical billing and revenue cycle management to Medicare home health agencies, hospice organizations, and palliative care teams across the United States. We handle coding, claims, payment posting, denial management, and A/R follow-up end to end — so your team can stay focused on patient care while your revenue cycle runs cleanly.
Typical home health & hospice care CPT range we work: G0151–G0154, G0299–G0300, Q5001–Q5009, 0023 (HIPPS), G0156.
Why home health & hospice care billing leaks revenue
PDGM LUPA threshold payment cuts: Episodes converted to drastically discounted per-visit rates when nurse visit milestones are missed by a single encounter
5-day Notice of Admission (NOA) late penalties: CMS reducing 30-day payment by 1/30th per day for late electronic intake transmission (CARC 253)
Hospice aggregate and inpatient respite cap clawbacks: Year-end Medicare MAC recoupments when per-beneficiary reimbursement exceeds statutory buffers
OASIS-E functional impairment scoring mismatches: Downcoding of HIPPS acuity groupings caused by discrepancies between therapy notes and OASIS submissions
How Aethera fixes it
Specialty-trained coders (CPC/CCS) code to the documentation
First-pass claim scrubbing against payer and NCCI edits
Proactive denial prevention and 72-hour denial work
Relentless A/R follow-up to drive days-in-A/R down
Eligibility and prior-auth verification before service
Transparent, real-time reporting in the provider portal
Free tools for your billing team
Use these any time — no login required.
Home Health & Hospice Care billing FAQ
How do you prevent Low Utilization Payment Adjustments (LUPAs) under PDGM?
We monitor active 30-day episode visit frequencies daily against patient-specific PDGM clinical thresholds (2–6 visits), triggering clinical coordinator alerts well before episode close to avert automatic downcoding.
How do you guarantee timely 5-day Notice of Admission (NOA) submissions?
Our billing engine receives start-of-care (SOC) intake data electronically and generates EDI 837I type of bill 32A transactions within 24 hours, completely eliminating late penalty reductions.