Home Health billing has specific differences from other types of services. There are physician certification requirements for ordering home health services.
The PDGM (Patient Driven Groupings Model) concept was developed effective in 2020 & this arrangement drives the correct reporting & reimbursement. HIPPS codes provide assessment of the patient’s ability to conduct certain activities (functional status) and the presence of any type of cognitive impairment to determine a payment group. HIPPS codes are required on all claims using revenue code 0023 on the UB 04.
We will review required documentation, completing the UB 04, & potential reimbursement changes for 2026
Dorothy Steed is an Independent Healthcare Consultant and Educator. She has served as a Medicare specialist and a physician audit supervisor for hospital systems with 50 years of experience in healthcare. She is an instructor at a state technical college and provides auditing & training in both facility and physician services. She is credentialed in medical coding, medical billing, medical auditing, utilization management, healthcare management, healthcare compliance, clinical documentation improvement, revenue cycle and patient accounts. Additionally, she has participated in multiple healthcare audits and investigations for both plaintiff and defendant She has provided review services for 2 state QIO organizations & served as an expert witness in several legal disputes. She holds a Master’s degree in Strategic Leadership Development.