Open Daily: 10am - 10pm | Alley door pickup 10am - 7pm 3038 Hennepin Ave Minneapolis, MN
612-822-4611

  • Open Daily: 10am - 10pm
    Alley-side Pickup: 10am - 7pm

    3038 Hennepin Ave Minneapolis, MN
    612-822-4611

Open Daily: 10am - 10pm | Alley-side Pickup: 10am - 7pm
3038 Hennepin Ave Minneapolis, MN
612-822-4611
The Complete Home Health & Hospice Billing Handbook: PDGM, OASIS, NOA, LUPA, Hospice Per Diem, Medicare Advantage, and Revenue Cycle Management

The Complete Home Health & Hospice Billing Handbook: PDGM, OASIS, NOA, LUPA, Hospice Per Diem, Medicare Advantage, and Revenue Cycle Management

Finch, Clive

Paperback

Series: Clive Finch Certification Exam Prep

Medical Reference

Currently unavailable to order

ISBN13: 9798171054663
Publisher: Independently Published
Pages: 292
Weight: 0.87
Height: 0.61 Width: 6.00 Depth: 9.00
Language: English
The HIPPS code is wrong. The NOA was late. The LUPA just triggered.These are the three most expensive billing failures in home health - and all three are preventable with the right operational framework. For CY 2026, home health agencies face a -4.059% permanent PDGM rate adjustment plus a temporary 5% recoupment reduction. Margins are tighter than they have been since PDGM launched. The agencies that survive this environment are the ones whose billing teams understand PDGM deeply enough to protect every dollar of payment that accurate documentation earns.This handbook is the complete operational reference for home health and hospice billing professionals, revenue cycle directors, agency administrators, and compliance officers navigating the 2026 billing landscape.What's Inside:20 chapters covering the complete home health and hospice billing framework. The Patient-Driven Groupings Model explained from first principles - the five PDGM variables, 12 clinical groupings, HIPPS code generation, and how OASIS accuracy directly determines payment. OASIS-E guide covering which assessment items drive payment, how to score correctly, CASPER submission requirements, and the expanded July 1, 2025 requirement that OASIS is now mandatory for all payers - not just Medicare. The Notice of Admission - the 5-day submission deadline, the $41.26 per day late penalty, common NOA errors, and a same-day submission workflow that eliminates avoidable penalties. LUPA risk management - LUPA thresholds by clinical group, real-time visit tracking, proactive scheduling strategy, and the financial impact of first-period LUPA events. Homebound status documentation - the specific clinical language that survives audit and the generic statements that don't. Diagnosis coding for PDGM - how principal diagnosis selection determines clinical grouping, how comorbidity coding affects payment, and the diagnoses that do not map to PDGM groups. Hospice billing - the four levels of care with 2026 per-diem rates, the hospice election requirements, benefit period structure, recertification, General Inpatient Care documentation, and cap period monitoring. Physician billing for home health and hospice - G0180, G0181, G0182, CPT 99341-99350, and when each applies. Medicare Advantage home health - prior authorization requirements, OASIS for MA patients, network verification, and MA payment rates. The Home Health Value-Based Purchasing program - HHVBP quality measures, OASIS as a HHVBP driver, HHCAHPS, and the 5% payment adjustment. Denial management - ADR response, NOA denials, homebound documentation denials, and hospice denial patterns. Fraud and abuse risk - the most frequently investigated home health and hospice schemes, physician kickback arrangements, and the hospice cap. Four PDGM case studies with calculated financial impact. PDGM compliance audit tool with five sections. NOA and claim submission checklist. LUPA risk management worksheet. Homebound documentation template. PDGM denial reason code reference. Compliance calendar with annual, quarterly, and monthly tasks.This is the operational reference for billing professionals who submit home health and hospice claims every day and need a single accurate source for the PDGM payment system, OASIS documentation requirements, NOA timing rules, hospice per-diem billing, and the 2026 changes that are reshaping the financial landscape for every home health agency in the country.Not affiliated with or endorsed by CMS or NAHC.

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