The How-To Guide to Home Health Billing, Second Edition

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The How-To Guide to Home Health Billing, Second Edition

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The How-To Guide to Home Health Billing, Second Edition

Joan L. Usher, BS, RHIA, ACE 

Home health care billing is a complicated task—to make sure you receive all the payment you’ve earned, accurate and compliant practices are a must. The How-To Guide to Home Health Billing, Second Edition, is your comprehensive, updated guide to the many elements involved in billing, helping you provide the best training possible to billing and other agency staff. With this book, you’ll increase employees’ competence and confidence about billing requirements and practices.

The new edition includes regulatory updates, such as:

  • General OASIS updates
  • ICD-10 coding
  • Payment adjustment information
  • G codes G0299 and G0300 regarding services of RNs/LPNs
  • Value-based purchasing and its impact on the bottom line


Table of Contents 

  • Home Health Billing Overview
    • Biller’s Role and Required Skills
    • Home Health Billing Overview
    • Who is Your MAC?
    • Types of Insurance Plans
    • Medicare Health Benefit
    • The Prospective Payment System (PPS)
    • Health Insurance Prospective Payment System (HIPPS)
    • Calculating the Episode
    • PC PRicer
  • Home Health Benefit Verification
    • Medicare Verification Through the FISS System
    • Which Insurance Is Primary?
  • Billing Requirements
    • Billing Software 101
    • Medicare Secondary Payer (MSP) Claims
  • Clinical Documentation Requirements for Billing
    • Eligibility
    • Documents Needed Before Billing
    • Tracking of Home Health Certification and Plan of Care (485)
    • Home Health Care CAHPS
  • Diagnosis Coding and the Billing Process
    • ICD-10-CM Specifics
    • Diagnosis Specifics
    • Coding Specifics
    • Value-Based Purchasing
  • Claim Submission
    • Paper Calim Versus Electronic Submission
    • Direct Billing by the Provider
    • Clearninghouse
  • Mastering the FISS 
    • FISS Main Menu
    • Cancelling a Claim
    • Claim Correction
    • Online Reports
  • Working the Remittance Advice
    • Forward Balances
    • Collections
    • Medicare Credit Balance Report (From CMS 838)Common 
  • Medicare Review: ZPIC/RAC/CERT/ADR
    • False Claims Act
    • Fraud and Abuse Specifics
    • Levels of Appeals
    • Additional Development Request (ADR)
    • MAC Top Denial Reasons
  • Resources
    • Helpful Listservs for Providers
    • Website Information
    • Acronyms
    • False Claims Act
  • Levels of Appeals


About the Author 

Joan L. Usher, BS, RHIA, ACE, is president of JLU Health Record Systems in Pembroke, Massachusetts. Usher is a nationally recognized expert in the field of coding and health information management. She has taught ICD coding in home health for 20 years and has educated more than 15,000 people nationwide. Her career began at a visiting nurse association, and she has been consulting for more than 25 years. Usher has been a certified OASIS specialist in the clinical realm for over nine years. She is a past president of the Massachusetts Health Information Management Association. 

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Published May 2016