What happens if OASIS data is incomplete or submitted late?

Our system flags OASIS assessments approaching their completion deadline and blocks claim generation for periods with an unlocked or non-compliant OASIS, since late OASIS submission can result in a payment reduction penalty under current home health regulations.

How are sequential 30-day payment periods within a 60-day episode managed?

Each 60-day certification period is split into one or two 30-day payment periods for billing purposes, and our system tracks the sequence (early vs. late period), automatically applying the correct timing categorization that affects the case-mix group calculation for each period.

What is a LUPA and how does the system help avoid it?

A Low-Utilization Payment Adjustment occurs when the number of visits in a 30-day period falls below the case-mix-specific threshold, converting the period's payment from the full case-mix rate to a per-visit payment. Our system tracks visit counts in real time against each period's specific LUPA threshold and alerts care coordination staff when a period is at risk so additional visits can be scheduled if clinically appropriate.

How does electronic visit verification (EVV) integrate with billing?

EVV records capturing visit type, caregiver identity, date, time, and location are matched against the visits billed on each claim before submission, with discrepancies flagged for resolution to ensure compliance with the 21st Century Cures Act EVV mandate and avoid claim denials or recoupments.

Does the system support the Notice of Admission (NOA) requirement?

Yes. The Notice of Admission must be submitted within 5 calendar days of the start of care for each 30-day period sequence, and our system tracks this deadline, generating and submitting the NOA automatically once admission documentation is complete to avoid the per-day payment reduction penalty for late submission.

How are high-cost outlier payments identified and billed?

Our system calculates estimated visit costs against the case-mix payment for each period and flags periods likely to qualify for outlier payments based on costs exceeding the fixed-dollar-loss threshold, ensuring the outlier payment is correctly calculated and included on the final claim.

What support exists for Home Health Value-Based Purchasing (HHVBP) measure tracking?

We track the OASIS-based and claims-based quality measures used in the HHVBP model, providing dashboards that show agency performance relative to cohort benchmarks so leadership can identify areas affecting the agency's payment adjustment under the program.

Home Health PM & RCM Software

Practice Management and RCM Billing Built for Home Health

Optimize PDGM 30-day payment periods, OASIS-driven reimbursement, and EVV compliance. See why home health practices choose Unlimited Systems for practice management and RCM software.

Why Home Health billing is different

Home health agencies bill under the Patient-Driven Groupings Model, where reimbursement for each 30-day payment period is determined by clinical grouping, functional status, and comorbidity adjustments derived directly from OASIS assessment data. Errors or delays in OASIS completion cascade directly into incorrect or delayed payments, while electronic visit verification requirements add another layer of compliance that, if mishandled, can trigger full episode recoupment. Unlimited Systems connects clinical documentation, OASIS scoring, and EVV compliance into a single revenue cycle workflow built specifically for PDGM.

Each 30-day payment period under PDGM is classified using the principal diagnosis, comorbidity adjustments, admission source (institutional vs. community), timing (early vs. late), and functional impairment level scored from the OASIS assessment, all of which combine to place the period into one of many case-mix groups with distinct payment rates. Every visit must be verified through an approved electronic visit verification system capturing the type of service, individual receiving the service, date, location, and time, with mismatches between EVV records and billed visits creating audit and recoupment risk.

Cost Savings Calculator

★★★★★4.8/5

★★★★★5/5

6,500+ specialty providersSOC 2 certified

Physician reviewing results at an office workstation

Product screenshot

Home Health workspace preview coming soon

HOME SPECIALTIESHome Health Agency RCM Software

Trusted Payer & EHR Integration Partners

Designed Around How Your Home Health Practice ACTUALLY Works

Our connected workflows are built to make you and your work easier to do and increase your revenue.

Visit-ready

Keep authorization and coverage aligned before the appointment is booked.

Claim-ready

Validate home health codes, modifiers, and documentation before submission.

Practice-ready

Give teams one view of denials, margin, and A/R priorities.

Real Home Health Practices, Real Results

See how home health groups across the country use Unlimited Systems to lift collections, cut denials, and reclaim staff time.

Featured Practice

Home Health Partners of the Midwest

Columbus, OH14-provider group practice

“Unlimited Systems gave our home health billing team the specialty-specific automation we could never get from a generic platform. First-pass claim acceptance climbed fast.”

- Director of Revenue Cycle

23%

Fewer denials

11 days

Faster A/R

Calculate Your RCM Revenue Leakage

Drag the sliders to estimate how much unrealized cash remains locked in your current specialty billing cycles before optimization.

Model your current claim volume

Adjust both inputs to match your practice.

Monthly specialty claims1,500

200 claims15,000 claims

Average claim value$250

$80 value$3,500 value

Estimated annual revenue recovered

$315,000

Calculated using a 7.0% reduction in write-offs from rejection recovery, pre-authorization verification, and drug-waste capture.

Monthly invoiced volume: $375,000
Standard industry loss: $31,875

Unlimited Systems Guarantee: Fully integrated bi-directional EHR triggers maintain first-pass bill submission scores above 98.6% across regional payer rules on day one.

Review my results

See your recovery estimate

Enter your work email to unlock your estimated annual recovery.

See Your Results Immediately5/55/54.8/5

One platform for every home health workflow

Eight connected capabilities, grouped around the way your practice works.

Front office

Keep registration and appointment calendars in sync.

Patient intake Scheduling

Before the visit

Verify coverage and catch charge risk early.

Financial clearance Charge validation

Revenue cycle

Post payments, route denials, and prioritize A/R.

Payment and denials A/R management

Practice intelligence

See margin, performance, and value-based results.

Analytics Value-based care

The Home Health suite

Every part of the home health revenue cycle, in one system

Each module is configured for the codes, modifiers, and payer rules home health teams work with, not adapted from generic billing software.

Home Health Patient Intake SoftwareCapture admission source (institutional vs. community) and verify home health benefit eligibility at referral intake.Home Health Scheduling SoftwareSchedule nursing, therapy, and aide visits according to the plan of care and 30-day period visit frequency requirements.Home Health Financial Clearance SoftwareVerify physician face-to-face encounter documentation and signed plan of care requirements for each episode.Home Health Charge Validation SoftwareCalculate and validate PDGM case-mix group placement from OASIS data, comorbidity coding, and admission timing.Home Health Payment Posting SoftwareManage Notice of Admission submission and final claim posting for each sequential 30-day payment period.Home Health AR Management SoftwareMonitor visit counts against LUPA thresholds and track high-cost outlier periods eligible for additional payment.Home Health Analytics SoftwareAnalyze case-mix group distribution, period revenue, and visit utilization trends across the patient census.Home Health Value-Based Care SoftwareReconcile electronic visit verification records against billed visits and track Home Health Value-Based Purchasing measures.

The cost of generic billing

You went into home health to treat patients, not to chase claims

These are the places home health practices most often lose revenue when their billing platform wasn’t built for the work. Unlimited Systems closes each one with rules configured for your specialty.

Review your workflow

Common home health revenue leaks

OASIS assessment errors or delays causing incorrect PDGM case-mix grouping and resulting payment miscalculations.
30-day payment period billing sequencing errors when patients have multiple consecutive periods within a single episode.
Electronic visit verification (EVV) data mismatches with billed visit records triggering compliance audits and recoupment risk.
Low-utilization payment adjustment (LUPA) thresholds missed, converting full 30-day period payments into per-visit-only reimbursement.

Challenges we solve for home health

The work that generic platforms leave to your staff is the work home health margin actually turns on.

PDGM Case-Mix Grouping

Integrated grouping engine calculates the HIPPS code directly from OASIS, comorbidity, and admission data tied to the claim.

Electronic Visit Verification

EVV records are reconciled against billed visits automatically before claim submission to prevent compliance gaps.

LUPA Threshold Monitoring

Real-time visit count tracking against the period's LUPA threshold allows proactive scheduling adjustments before period close.

Legacy software vs. Unlimited Systems

See why home health practices move off general-purpose billing platforms.

CRITERIA

LEGACY SYSTEM COMPROMISE

UNLIMITED SYSTEMS VALUE

PDGM Case-Mix Grouping

✕Case-mix group calculations are performed disconnected from billing, causing claims to be submitted with mismatched HIPPS codes.

✓Integrated grouping engine calculates the HIPPS code directly from OASIS, comorbidity, and admission data tied to the claim.

Electronic Visit Verification

✕EVV data lives in a separate system disconnected from billing, creating mismatches that surface only during audits.

✓EVV records are reconciled against billed visits automatically before claim submission to prevent compliance gaps.

LUPA Threshold Monitoring

✕Agencies don't know a period will fall under the LUPA visit threshold until after the period closes and revenue is lost.

✓Real-time visit count tracking against the period's LUPA threshold allows proactive scheduling adjustments before period close.

Still evaluating

Not Ready to Switch Yet? That's Exactly When to Start the Conversation.

You don't have to be actively replacing your current system to have a useful conversation with Unlimited Systems. Many specialty practices talk with us months before a contract renewal, system evaluation, or operational change so they can understand where revenue leakage, denial risk, prior authorization delays, and reporting gaps may already be showing up.

Get a Demo Benchmark Your Current Workflow

You don't have to wait until your contract is up to start evaluating your options. The best time to assess your revenue cycle technology is before renewal pressure begins. Unlimited Systems can help you understand where your current workflows may be creating avoidable denials, manual work, charge capture gaps, or reporting limitations, so you're better prepared for renewal, replacement, or future planning.

Less billing work between the visit and payment

Specialty rules and connected data keep your team focused on the exceptions that need judgment.

Verify before the visit

Coverage and authorization stay tied to the order.

Validate specialty charges

Code, unit, and modifier checks happen before filing.

Work the right accounts

Denials and A/R are ranked by value and filing risk.

Care team in scrubs walking through a clinic corridor

35%less manual workflow time

One platform

The rest of the platform your home health practice runs on

The same connected system handles the operational work that sits either side of billing.

Patient Intake

Digital intake, eligibility, and demographic capture before the visit.

Explore Patient Intake

Patient Scheduling

Smart calendars and resource scheduling across providers and locations.

Explore Patient Scheduling

Financial Clearance

Automated eligibility checks and prior authorization management.

Explore Financial Clearance

Charge Validation

Pre-claim scrubbing for coding, modifiers, and compliance accuracy.

Explore Charge Validation

Built for home health

Follow one home health patient from intake to payment

Eight stages, one record. Nothing is rekeyed between systems, so a detail captured at the front desk is still there when the claim goes out, and when the remittance comes back.

Walk the workflow with us

Frequently asked questions

Our grouping engine combines the principal diagnosis category, secondary diagnosis comorbidity adjustments, admission source (institutional or community), period timing (early or late within the 60-day episode), and the functional impairment level derived from specific OASIS items to calculate the correct HIPPS code for each 30-day payment period.

New to revenue cycle terminology? Browse our healthcare RCM & billing glossary.

We Love Hearing From Our Users

Practices like yours, on what changed after moving to Unlimited Financials.

EXPLORE PRODUCTS GET A DEMO

★★★★★4.8/5

★★★★★5/5

“

I'd love to set up a call to talk about SCOA, and the success we've had with Unlimited Financials.

Sam Wheeler

CFO, SCOA

“

The system continues to grow with features as it should, with how healthcare changes. So, if you are looking for a company that is innovative and truly cares, I would recommend Unlimited Financials.

Ernelita Dacumos

Billing Manager, SHOM

“

Unlimited Financials has been the easiest and best practice management system I have used. It is easy to navigate and do what I need to do.

Melissa Shook

Medical Biller, SHOM

“

I would recommend Unlimited Financials to other specialty practices.

Michelle Leandri

CEO, NEPA

“

We transitioned to Unlimited Financials in 2024... the team and platform are absolutely amazing.

Gina

Administrator, FOUR

“

We have been on Unlimited Financials for over three years and love it. Our claims are being processed faster and more efficiently, which means we are receiving payment more quickly.

Renee Bernacchi

Accounts Receivable Coordinator, COAS

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