Question 1

What is PDGM and why does it matter for billing?

Accepted Answer

PDGM (Patient-Driven Groupings Model) replaced PPS for home health in 2020. It divides episodes into 30-day periods classified by referral source, timing, clinical grouping, and functional level. Incorrect PDGM classification directly reduces reimbursement — often without a denial, just a lower payment.

Question 2

Do you integrate with HHAeXchange?

Accepted Answer

Yes. We integrate directly with HHAeXchange for EVV data validation and billing. We also support Netsmart/Tellus for agencies in the Florida fee-for-service delivery system.

Question 3

What is the difference between community care and institutional home health billing?

Accepted Answer

Community care uses professional claims (CMS-1500) for HHA and PCA services billed by visit. Institutional home health uses UB-04 claims under PDGM for certified skilled nursing and therapy episodes. Both run through our platform under separate billing tracks.

Question 4

How do you handle Florida Medicaid managed care billing?

Accepted Answer

We bill all active Florida Medicaid MMC plans including Sunshine Health, Humana Medicaid, Molina Healthcare, and Simply Healthcare. We maintain current fee schedules and payer-specific rules for each plan.

Home Health Billing.
Florida specialists.

What we handle for home health billing.

Frequently asked questions.

Home Health Billing.Florida specialists.

What we handle for home health billing.

Frequently asked questions.

Home Health Billing.
Florida specialists.