Does the AI handle PDGM 30-day periods and RAP/NOA timely filing?

Yes. RCM Employee is built around the PDGM payment model, splitting care into 30-day periods. The Digital FTEs track the Notice of Admission (NOA) and RAP timely-filing deadlines and flag any period at risk of a late-NOA penalty before it costs the agency revenue.

Can AI bill 837I institutional home health claims?

Yes. The Digital FTEs scrub and submit 837I institutional claims for each 30-day period, validate HIPPS coding context from the OASIS assessment, and follow up on claim status (276/277). Coding sign-off and submission sit behind a human-approval gate.

How does AI use OASIS data in home health billing?

OASIS drives the clinical and functional grouping that determines the PDGM case-mix and HIPPS code. RCM Employee uses the OASIS-driven coding context to align diagnoses and the institutional claim with the assessment, reducing case-mix mismatches and downcoding denials.

Home Health Agency Billing Automation with AI (PDGM & OASIS)

Home health billing is among the most unforgiving corners of the revenue cycle: PDGM 30-day periods, strict Notice of Admission and RAP timely-filing deadlines, OASIS-driven case-mix, and institutional 837I claims. A single late NOA can wipe out a period's payment. This guide explains how AI automates the full home health revenue cycle for U.S. agencies.

Short answer: RCM Employee provides 12 AI "Digital FTEs" that run home health agency billing end to end — eligibility and benefit checks (270/271), prior authorization (278), OASIS-driven coding, claim scrubbing and submission of institutional 837I claims, A/R follow-up (276/277) with timely-filing alerts, payment posting (835), and denials and appeals. It is API-first and HIPAA-compliant, with a human-approval gate before anything is submitted.

Why home health billing is harder than most settings

Under the Patient-Driven Groupings Model (PDGM), each episode of care is split into 30-day payment periods, and reimbursement is driven by clinical grouping, functional level, comorbidity, and admission source rather than therapy volume. Layered on top are the Notice of Admission (NOA) and RAP timely-filing rules, where a missed deadline triggers a per-day payment reduction. The OASIS assessment sets the case-mix, and claims are institutional 837I rather than professional. RCM Employee's Digital FTEs are built to handle exactly these moving parts at scale.

PDGM 30-day periods — each episode managed as discrete 30-day payment periods, with case-mix and HIPPS grouping aligned to the OASIS assessment.
RAP / NOA timely filing — Notice of Admission and RAP deadlines tracked per period, with alerts before a late-NOA penalty applies.
OASIS-driven coding context — diagnoses and functional grouping aligned to the OASIS data that determines the case-mix.
837I institutional claims — institutional claim format validated and submitted, distinct from professional 837P billing.

How the Digital FTEs run the home health revenue cycle

Each stage of the home health cycle is owned by a specialized AI agent, coordinated by a Commander. The work flows automatically from admission to payment:

Eligibility & benefits (270/271) — verifies coverage, benefit periods, and home health eligibility before admission.
Prior authorization (278) — detects when auth is required, submits the request, and tracks approvals across the episode.
OASIS-driven coding — aligns diagnoses and functional grouping with the OASIS assessment to support the correct PDGM case-mix and HIPPS code.
Claim scrub & submit (837I) — validates the institutional claim for each 30-day period and submits electronically through the clearinghouse.
A/R follow-up (276/277) — checks claim status, works aging buckets, and raises timely-filing alerts.
Payment posting (835) — parses remittance, posts payments, and identifies underpayments.
Denials & appeals — analyzes denial reasons and drafts evidence-based appeals.

Episode management and timely-filing protection

Where AI earns its keep: home health agencies lose real money to late NOAs and missed period boundaries. The Digital FTEs treat each episode as a sequence of 30-day periods, watch every Notice of Admission and RAP deadline, and surface timely-filing alerts well before the penalty window. They trace denials to their root cause — a late NOA, a case-mix mismatch against OASIS, or an institutional claim error — and assemble an appeal citing the documentation and payer policy. The goal is to recover revenue that manual teams often write off.

HIPAA, security, and human oversight

Home health data is sensitive PHI that flows between the field, the office, and payers, so security is foundational, not an afterthought. RCM Employee encrypts data at rest with AWS KMS and in transit with TLS, isolates every practice's data per practice, and maintains a Business Associate Agreement chain across all PHI-touching parties. Every action is recorded in a 7-year audit log, and a human-approval gate stands in front of every claim submission, payment posting, and appeal. The platform is API-first by design — it connects to payers, clearinghouses, and EHRs through APIs and never uses browser automation or screen scraping.

Pricing for home health agencies

RCM Employee uses a transparent, credit-based model — no per-claim fees and no token math. Pay-as-you-go starts at a $250/mo minimum, billed monthly, so smaller agencies can scale with their census. For higher-volume home health agencies, the Standard plan is $3,500/mo and the Professional plan is $5,500/mo, billed monthly. Every plan includes the full team of 12 Digital FTEs.

Frequently asked questions

Does the AI handle PDGM 30-day periods and RAP/NOA timely filing?: Yes. RCM Employee is built around the PDGM payment model, splitting care into 30-day periods. The Digital FTEs track the Notice of Admission (NOA) and RAP timely-filing deadlines and flag any period at risk of a late-NOA penalty before it costs the agency revenue.
Can AI bill 837I institutional home health claims?: Yes. The Digital FTEs scrub and submit 837I institutional claims for each 30-day period, validate HIPPS coding context from the OASIS assessment, and follow up on claim status (276/277). Coding sign-off and submission sit behind a human-approval gate.
How does AI use OASIS data in home health billing?: OASIS drives the clinical and functional grouping that determines the PDGM case-mix and HIPPS code. RCM Employee uses the OASIS-driven coding context to align diagnoses and the institutional claim with the assessment, reducing case-mix mismatches and downcoding denials.
Is patient home health data kept secure?: Yes. Data is encrypted at rest with AWS KMS and in transit with TLS, isolated per practice, covered by a BAA chain, and recorded in a 7-year audit log. A human-approval gate sits in front of every submission.

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