Choosing a billing company isn’t just about cost. The real test of a good biller is in their process. You need to know…
- how they work,
- how they communicate,
- and how they prevent your revenue from slipping through the cracks
…before you get close to even looking at a contract.
At The Home Health Consultant, we help home health and hospice agencies improve their operational efficiency and survey readiness. One of the ways we’ve seen great agencies get held back is by choosing the wrong biller.
In this article, we’ll cover how to find the best biller for your home health and hospice agency, by sharing questions you need to be asking about their process to find the best fit.
*This article was written in consultation with Mariam Treystman.
What Should You Expect During a Home Health or Hospice Biller’s Onboarding Process?
One of the most overlooked questions home health & hospice agencies fail to ask billers is:
“What does your onboarding process look like?”
Onboarding can range from same-day activation to a six-week setup period. And even then, it’s dependent on the biller’s size, systems, and insurance types.
If you’re switching billers, this question is critical. You’ll want to avoid a gap between letting one biller go and waiting weeks for the new one to start.
Whatever timeframe a biller provides, assume the longest end of that range. That’s usually the more realistic timeline based on their past experience with other clients.
Ask follow-up questions such as:
- Do you handle portal setups for Medicare Administrative Contractors (MACs) and insurance connections?
- What information do you need from my team before you can begin?
- Who will be my main contact during onboarding?
The best billers will walk you through how to make the transition smooth and help you avoid preventable delays.
How Does the Home Health or Hospice Biller Actually Submit Claims?
Not all billers submit claims the same way. Understanding how they bill is just as important as when.
Ask directly:
“Do you bill manually through Direct Data Entry (DDE),
or do you use automated software?”
In home health and hospice billing, there are three main billing methods:
- Direct Data Entry (DDE) through your MAC portal
- Uploading claim files through an intermediary system (such as PracticeSuite or Inovalon, for example)
- Automatic submission directly from your Electronic Medical Record Software (EMR)
Each method has its pros and cons. Manual DDE provides the most visibility into errors and claim adjustments. Automated transmission through EMR systems can be faster, but only if the biller understands the timing and cutoff rules for each software.
A well-informed biller should be able to explain:
- Whether your EMR queues claims before sending
- How often it transmits to Medicare
- When the system retrieves results
Knowing these details helps you prevent missed submission windows and understand how long it takes for a claim to truly reach Medicare.
How Will a Home Health or Hospice Biller Communicate With You?
Every billing relationship depends on communication. Ask:
“How will you communicate with our team?
Through email, phone, or a portal?”
If they use a portal, find out whether you’ll receive email alerts when new messages appear or if your team has to log in regularly. These small details can prevent big miscommunications.
It’s also worth asking whether you’ll have a dedicated account representative or if your claims will be handled by a rotating team. Both models have pros and cons. Dedicated reps offer continuity and personal accountability, while larger teams can provide faster turnaround if one person is unavailable
Does the Home Health or Hospice Biller Send Reminders or Alerts for Deadlines?
We just reviewed communication, but many agencies underestimate the value of proactive communication. Not having this can mean late claims and a lot of lost revenue. So, you should also ask a potential biller:
“Do you send reminders for upcoming deadlines
or important submissions?”
Some billers go beyond claim processing by sending reminders about cutoff times or key compliance dates. For example, this could include when your Hospice CAP submission is due. Others focus solely on billing. Knowing which category your potential biller falls into will help you plan accordingly.
If they do send reminders, clarify how and when they send them. Do the reminders come as:
- An automated email?
- A weekly summary?
- A personalized notice from your account rep?
The goal is to understand whether they’ll help keep you ahead of critical deadlines or if your team will need to track them independently
How Does the Home Health or Hospice Biller Handle Credit Balances and Overpayments?
Credit balances occur when the agency owes money back to Medicare or another payer, often due to overpayments. Federal rules require agencies to report and refund these overpayments promptly. So, it’s essential to ask your biller:
“What do you do when there’s a credit balance?”
Some billers take a hands-off approach, leaving it to the agency to track balances. Others proactively reconcile and flag them. Understanding which approach your biller takes can prevent compliance issues and frustration down the line.
Does the Home Health or Hospice Biller Perform Accuracy or Quality Checks Before Submitting Claims?
Before a claim ever leaves your EMR, ask:
“Do you perform any quality or compliance
checks before submission?”
An experienced biller should confirm timeliness, correct billing periods, and clean data to avoid unnecessary rejections.
Sometimes smaller billing vendors can offer more meticulous oversight. This is because the same person entering the claim is also the one responsible for accuracy.
Larger billing companies, on the other hand, commonly rely on standard workflows that prioritize output over review.
Will the Home Health or Hospice Biller Reconcile Claims and Process Remittance Advices (RAs)?
Once you’ve asked your potential biller about quality checks, your next question should be:
“Do you reconcile claims with payments,
and how often do you process RAs?”
A biller’s reconciliation process is the systematic review and comparison of claims submitted versus payments received from Medicare or other payers. In other words, it’s how they verify that every claim billed was paid accurately and completely. This process ensures no claim slips through the cracks and that your agency’s revenue matches the work performed.
Remittance Advices (RAs), also known as Explanation of Benefits (EOBs), are the detailed payment reports sent by Medicare or other payers. These documents list which claims were paid, denied, or adjusted, along with the reasons why.
Some billers reconcile daily or weekly, while others only do it monthly. You’ll want a process that ensures you’re immediately aware of underpayments or missing claims, especially in home health (because delayed NOA’s can prorate the claim to $0 within 30 days). Ask what they do if claim amounts don’t match the payments received.
This level of vigilance can help you identify issues like PECOS-related denials or missed cost reports before they spiral into lost revenue.
Is the Home Health or Hospice Biller Familiar With Your EMR System?
Billing software isn’t perfect, every biller is different, and every EMR has its quirks. That’s why it’s essential to ask:
“Are you familiar with our EMR system?”
A biller who knows your EMR’s common bugs and workflow shortcuts can prevent recurring errors and delays. For example, they might already know that a certain diagnosis code sequence causes issues or that claim transmissions fail if certain fields are missing. That knowledge helps them troubleshoot faster than even the EMR’s own support team.
This familiarity also signals that they likely serve multiple clients using the same system. This is a green flag because it means they’ve seen common issues across different agencies. They may be able to proactively warn you about new bugs or updates
For Hospice Only: Does The Biller Support Hospice CAP Submissions?
If your agency provides hospice services, ask:
“Do you assist with Hospice CAP submissions?”
Not every biller does. Some will handle the data preparation but leave the final submission to your agency. Others will walk you through the process or even file on your behalf. Clarifying this up front ensures you’re not left scrambling at the end of the fiscal year.
How to Find the Best Home Health or Hospice Biller for Your Medicare Agency
At the end of the day, it’s not about finding the perfect billing company, it’s about finding the one that best serves your agency and their needs.
- Large companies may offer structured processes but less personal attention
- Smaller billers often provide more hands-on service and communication, but offer fewer features and inconsistent results
Again, what matters most is alignment: does their process match the way your agency operates? If they do, they’re likely a great fit for your agency.
If you’re looking for a biller, there’s a good chance you’ll also be looking for a survey consultant soon. For a breakdown on whether your agency would benefit more from compliance or mock survey consultants, read the article below.
And if you missed it, make sure to check out part one of this article by clicking below.
*Disclaimer: The content provided in this article is not intended to be, nor should it be construed as, legal, financial, or professional advice. No consultant-client relationship is established by engaging with this content. You should seek the advice of a qualified attorney, financial advisor, or other professional regarding any legal or business matters. The consultant assumes no liability for any actions taken based on the information provided.
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