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Course

Home Health Billing and Reimbursement

Contact Hours Awarded: 3

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Course Overview

Home Health Billing and Reimbursement

Author: Joanna Grayson
BSN, RN

Home health care enables qualified clients to receive skilled medical treatment in their homes, reducing healthcare costs. However, due to the increased number of clients receiving home health care, government regulations, and third-party payor restrictions, the billing and reimbursement process has become very convoluted and cumbersome for home health agencies (HHAs).

Home health care is a multi-billion-dollar industry that is growing exponentially not only due to the aging of America but also because private equity funds and large insurance companies are buying smaller, independent agencies and rolling them into larger, corporate home health agencies that demand higher profits.

Home health agencies are burdened with constantly training clinicians and billing professionals to help them keep abreast of changes in the industry that impact the HHAs’ bottom lines. Nurses need to understand the home health billing and reimbursement process to assist their HHA employers in maintaining financial stability, ensuring regulatory compliance, and delivering optimal care to clients.

Course Outline

  1. Introduction
  2. Initial Steps of the Home Health Care Billing Cycle
  3. Billing Codes Used in Home Health Care
  4. Next Steps in the Home Health Care Billing Cycle
  5. Medicare Home Health Care Services and Billing
  6. Medicaid Home Health Care Services and Billing
  7. CMS Alternative Payment Models
  8. Home Health Value-Based Purchasing Model
  9. PDGM Audits
  10. Home Health Agency Billing Challenges
  11. The Future of Home Health Care Billing
  12. Conclusion
  13. Final Reflection Questions
  14. References

Accreditation Statement

Nursing CE Central LLC is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

In this course, we will discuss Home Health Billing and Reimbursement. It will take the average learner 180 minutes to complete and awards 3 contact hours of continuing education.

Course Outcomes

After completing this course, the learner will rate a 4 out of 5 on the Likert Scale for their ability to:

  1. Describe the steps of the home health care billing cycle.
  2. List the most common billing codes used in the home healthcare industry.
  3. Compare Medicare and Medicaid home health services and billing information.

Target Audience

  • Registered Nurses (RN)
  • Advanced Practice Registered Nurses (APRN)
  • Licensed Practical Nurses (LPN/LVN)

Requirement for Completion

  1. Enrollment in the course by the learner
  2. Read and learn all course materials
  3. Complete the course evaluation
  4. Attest and testify learning of the course materials

Accreditations + Approvals

  • American Nurses Credentialing Center (ANCC) (P0614)
  • California Board of Registered Nursing (CEP 17418)
  • Kentucky Board of Nursing (7-0090)
  • Louisiana State Board of Nursing (58)
  • New York State Department of Education (IC 208)
  • New York State Department of Education Child Abuse #80996
  • Florida Board of Nursing (50-23983)

Disclosure of Relevant Financial Relationships

Nursing CE Central nor any of the authors, planners, content experts, or any contributors have any relevant financial relationships with ineligible companies to disclose.

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Course created on: March 21, 2025

Course Expires on: March 21, 2028

Course Offering: #690