A single PDGM timing category error — coding a period "early" when it should be "late" — can cut a claim's payment by 10-15%. Add no-pay RAP deadlines and OASIS grouping accuracy on top, and discipline is the whole game.
Common Billing Challenges
These are the six billing failure points we see most often in home health agencies — and the ones our team resolves systematically from day one.
A period coded "early" when it should be "late" (or vice versa) directly reduces payment by 10-15% on that claim — one of the most common and most costly PDGM mistakes.
Under the no-pay RAP model, missing the 5-day submission window from start of care triggers a payment reduction that compounds for every day late — a pure cash flow leak.
Payers need the specific reason leaving home requires a considerable, taxing effort — vague language like "patient is frail" doesn't survive appeal.
Nursing and therapy notes need to clearly establish why skilled care was medically necessary for that visit — documenting what was done isn't the same as documenting why it required a skilled provider.
When the plan of care doesn't match the services actually billed, that's a denial or a costly adjustment — orders need reconciling against visit notes before billing, not after.
The OASIS-set functional impairment level directly affects payment — the gap between medium and high can be $200-$400 per 30-day period, and errors here compound across every episode.
Key Billing Elements
Our coders hold specialty-specific credentials and train continuously on the rules that drive the most revenue — and the most denials — in home health.
| Element | Description | Common Issue |
|---|---|---|
| PDGM Timing | Early vs. late 30-day period classification | Miscoded timing cuts payment 10-15% |
| RAP / NOA | Notice of Admission submission | Must submit within 5 days of start of care |
| OASIS M-codes | Clinical grouping and functional level source data | Confirmed before finalizing grouping |
| Functional Level | Low / medium / high impairment classification | $200-$400/period swing between medium and high |
| Homebound Documentation | Specific functional basis for homebound status | Generic language doesn't survive appeal |
| RPM Billing | Remote patient monitoring codes | Often not coded at all despite eligible services |
Why Rcmaxis
We're not a generalist billing service that added a specialty module. Our team is built around specialty-specific expertise.
Every coder on your account holds the specialty coding credential relevant to home health — not a generic CPC only.
Significantly above the 13.1% industry denial rate for this specialty. Fewer rejections means faster payment and less write-off risk.
Full EHR integration, payer enrollment verification, and charge capture setup in 2 weeks — with zero disruption to your care schedule.
One point of contact who knows your agency, your payers, and your billing history — available for weekly calls and monthly performance reviews.
Month-to-month engagement. We earn your business every month by improving your collections — not by locking you in.
Live visibility into your collections, denial rate, aging AR, and payer performance — updated daily, reviewed monthly with your account team.
Straight answers to what agencies usually ask before they switch.
Free revenue assessment for qualified agencies. We audit your last 90 days of claims, identify every revenue leak, and show you a clear path to better collections — at no cost.