Master PDGM & OASIS
For Maximum Agency Revenue
Home health billing leaves no room for error. From timely Notice of Admission (NOA) submissions to flawless OASIS-to-claim matching and LUPA management, we ensure your agency gets paid fast and in full.
Zero Timeliness Penalties
We strictly manage Medicare’s 5-day Notice of Admission (NOA) window to ensure you never lose a percentage of your 30-day episode payment.
Why Home Health Billing Demands Specialists
Under the Patient-Driven Groupings Model (PDGM), home health billing shifted from volume-based to value-based. Coding inaccuracies between your OASIS data and the primary diagnosis can drop your Home Health Resource Group (HHRG) score, costing your agency thousands per episode. We connect the clinical dots to maximize your reimbursement.
NOA Submission Mastery
Medicare requires the Notice of Admission (NOA) to be accepted within 5 days of the start of care. We monitor DDE/FISS daily to ensure immediate acceptance and zero financial penalties.
PDGM & OASIS Alignment
A mismatch between your OASIS data and billed ICD-10 codes leads to Return to Provider (RTP) claims. We scrub every clinical grouping to ensure accurate HHRG case-mix weights.
LUPA Threshold Management
Missing the visit threshold triggers a Low Utilization Payment Adjustment (LUPA), paying you only per visit instead of the full episode. We proactively track visits to prevent this.
Securing Revenue from
Admission to Final Claim
We meticulously manage your 30-day payment periods, ensuring every visit is captured and compliance documentation is airtight before submission.
Intake & NOA
The moment a patient is admitted, we verify Medicare/Commercial eligibility and instantly submit the Notice of Admission to secure your 30-day payment period.
OASIS Scrubbing
Our specialized coders review the completed OASIS assessment against physician orders, ensuring the primary diagnosis maps to a valid PDGM clinical grouping.
Final Claim Submission
At the end of the 30-day episode, we verify all physician face-to-face (F2F) encounters and signatures are on file before submitting the final claim (TOB 329).
ADR & Audit Defense
If Medicare triggers an Additional Documentation Request (ADR), we quickly compile your clinical notes, orders, and assessments to defend and recover your payment.
Stop Losing Daily Revenue to
Late NOA Submissions
Partner with certified home health billers who understand PDGM, OASIS matching, and Medicare ADRs. Contact Valeria Healthcare Solutions today for a free agency audit.