Billing & Revenue Cycle
Home Health Billing Software Built for PDGM
Home health billing is not generic medical billing: PDGM payment periods, LUPA thresholds, five-day NOAs, sequential billing, and EVV reconciliation all have to line up. EMRxAI runs the full revenue cycle from admission through payment - on the same chart the clinicians document in.
Built specifically for Medicare-certified home health agencies. HIPAA-compliant by design.
Billing problems start weeks before billing
When billing runs in a separate system from clinical documentation, billers spend their days reconciling: chasing missing notes, matching visits to orders, retyping data, and discovering at claim time that the chart cannot support the claim.
Every handoff between systems is a place revenue leaks - unbilled visits, mismatched codes, missed NOA deadlines, and periods that quietly went LUPA.
The revenue cycle in one system
Claims from the verified chart
Claims are assembled from QA-verified documentation and EVV-verified visits - no cross-system reconciliation.
PDGM period management
30-day payment periods, sequential billing, LUPA thresholds, and outlier tracking are managed automatically.
Deadline protection
Five-day NOA tracking and recertification deadlines are monitored on every admission with escalating alerts.
Payroll from verified visits
Clinician pay is calculated from EVV-verified, documentation-complete visits - so payroll, claims, and the chart always agree.
Admission to payment
- 1
Eligibility verified at intake
Payer details are confirmed before the first visit.
- 2
Documentation verified continuously
Real-time QA keeps the chart claim-ready throughout the episode.
- 3
Claims scrubbed and submitted
Chart-matched, PDGM-aware claims go out clean.
- 4
Cash and payroll reconciled
Payments post against periods; payroll runs from the same verified visit data.
An audit trail from visit to payment
Because billing, documentation, and EVV live in one system, every billed visit traces to a verified, documented, ordered visit - the chain of evidence ADR reviewers and auditors ask for.
Honest expectations
- Clean-claim tooling is designed to prevent avoidable denials and accelerate cash - it does not guarantee payer payment timelines or acceptance.
- Savings and denial-reduction figures depend on agency baseline, payer mix, and volume; a walkthrough can model your numbers with stated assumptions.
Frequently asked questions
Does EMRxAI replace our billing service?
It can support either model: in-house billers work directly in the platform, or your outsourced billing partner can work from the same verified data with appropriate access.
Which payers are supported?
Traditional Medicare, Medicare Advantage, Medicaid, and commercial payers - with payer-specific rules, authorization tracking, and eligibility verification.
How does payroll tie into billing?
Both run from the same EVV-verified visit records. A visit that is payable to the clinician is the same visit that is billable to the payer - discrepancies surface immediately instead of at audit.
See it on your agency's workflows
A walkthrough tailored to your census, payer mix, and current baseline - with any savings estimate documented, assumptions included.
Request a Demo