Overview
Home health billing runs on 30-day payment episodes under Medicare's Patient-Driven Groupings Model (PDGM), where reimbursement is calculated directly from OASIS assessment data and physician certification requirements. A documentation gap in the OASIS record shows up as a reimbursement gap on the claim. AspireMedX keeps that link intact.
Where claims usually go wrong
A missing or late physician certification is one of the fastest ways an otherwise well-documented home health episode gets denied outright. We track certification and recertification deadlines per episode so a signature gap never holds up payment.
What we handle
- ✓PDGM episodic billing and case-mix group verification against OASIS data
- ✓Physician certification and recertification tracking for each episode
- ✓Face-to-face encounter documentation compliance
- ✓Low-utilization payment adjustment (LUPA) monitoring
- ✓Visit frequency and plan-of-care alignment across the episode
Talk to us about home health billing
info@aspiremedx.com · +1 (716) 242-2898
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