Home health billing software: what it has to do, and how to choose

What home health billing software has to handle under PDGM, the five-day NOA and LUPA, how the main options describe their billing, and the questions to ask before you buy.

Author

Enzo Health Team

Enzo Health

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Read Time: 5 min read

Date: November 3, 2026

The short answer. Home health billing software turns a finished chart into a Medicare claim and gets it paid. Under PDGM that means billing in 30-day periods, filing the Notice of Admission within five days of the start of care, and catching low-visit periods before they cost you. Every large home health EHR below describes billing as part of its system [4][5][7][8][9]. The difference to look for is where errors get caught: before the claim goes out, or after it comes back denied.

Key takeaways

Medicare pays home health in 30-day periods, not 60-day episodes, since January 1, 2020 [1].
The NOA is due within 5 calendar days of the start of care. File it late and the period's payment drops by 1/30th for each day from the start of care until it is filed [2].
A period with too few visits for its payment group pays per visit instead (a LUPA) [3].
A claim is only as right as the chart and codes it comes from. Ask what gets checked before it goes out.
None of the six vendors below shows a price on the pages we read on October 30, 2026. Ask for the all-in number.

What does home health billing software actually do?

Four jobs, in this order.

Files the Notice of Admission. One NOA per admission, to your Medicare contractor, inside five days.
Builds the claim from the chart. Diagnosis codes, the OASIS answers and the visits on the schedule decide the payment group. If the chart is wrong, the claim is wrong.
Checks before it sends. Missing signatures, mismatched codes, a visit count heading for a LUPA. Caught here, it costs minutes.
Tracks what comes back. Payments, denials, rework, for Medicare and every other payer you bill.

The first three decide most of your cash. The fourth is where you find out how the first three went.

Billed separately or inside your EHR?

Inside the EHR. The claim comes from the same record the clinician charted in. Nothing is re-keyed. Every vendor below describes billing this way.

A billing service. A company works your claims for a fee. Useful when you have no biller. The chart still comes from your EHR, so errors made upstream still arrive.

A separate billing tool. One more system to keep in step with the chart, and one more place for a code to change between the visit and the claim.

If you are choosing an EHR, you are choosing your billing. Judge both together.

How do the main options describe their billing?

Each line is the vendor's own words, from its own site, read on October 30, 2026. Listed alphabetically.

Alora. "Unlike billing companies that enter the revenue cycle after a claim is created, Alora fixes workflow failures before submission." [4]
Axxess. "Get paid more and get paid faster by all payors with our real-time, automated claims processing so you can grow your business and focus on patient care." [5]
Enzo. "Once a chart clears review, Enzo prepares the claim and flags only what needs a decision." Enzo checks codes and documentation before the claim goes out. [6]
Homecare Homebase. "From documentation to billing to analytics, HCHB brings your entire operation into one secure, integrated system." [7]
KanTime. "KanTime enables users to electronically invoice, post, track, and manage claims all in one place." [8]
WellSky. "Our home health software solution expedites the claims process for managed care and Medicare patients to shorten and improve your home health billing revenue cycle." [9]

Every one of them says billing. Ask each to show you a claim from a real chart, start to finish, on your own payer mix.

Five questions to ask before you buy

Who files the NOA, and what warns us on day four? A late NOA is money you never get back.
What gets checked before a claim goes out? Codes, OASIS answers, signatures, visit counts. Ask to see the list.
What happens to a chart that fails a check? Who sees it, with what explanation, and how fast.
How do we see a period heading for a LUPA before it closes? The fix is a visit, not an appeal.
What is the all-in monthly number? Billing, clearinghouse, payer connections, every add-on. Get it in writing.

Frequently asked questions

Is home health billing different from other medical billing?

Yes. Medicare pays home health per 30-day period under PDGM, with a payment group set by diagnosis, function from the OASIS, and timing and source of the admission [1]. The NOA and LUPA rules exist only here [2][3].

What happens if the NOA is late?

The period's payment drops by 1/30th for each day from the start of care until the NOA is filed [2].

What is a LUPA?

A low-utilization payment adjustment. When a 30-day period has fewer visits than its payment group's threshold, Medicare pays per visit instead of the full period rate [3].

Should a small agency outsource billing?

If you have no biller, a service can carry you. You will still need clean charts, because the service bills what your EHR sends it.

Do I need billing software if my EHR has billing?

Start by asking what your EHR checks before a claim goes out. That is where a second tool would have to earn its cost.

Sources

CMS, Home Health Prospective Payment System. cms.gov/medicare/payment/prospective-payment-systems/home-health (read Oct 30, 2026)
CMS, MLN Matters MM12256, Notice of Admission. cms.gov/files/document/mm12256.pdf (read Oct 30, 2026)
CMS, Medicare Claims Processing Manual, chapter 10, Rev. 13089. cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c10.pdf (read Oct 30, 2026)
Alora, RCM and billing management. alorahealth.com/rcm-billing-management (read Oct 30, 2026)
Axxess, Revenue cycle management. axxess.com/revenue-cycle-management (read Oct 30, 2026)
Enzo, EHR. enzo.health/ehr (read Oct 30, 2026)
Homecare Homebase, home page. hchb.com (read Oct 30, 2026)
KanTime, home page. kantime.com (read Oct 30, 2026)
WellSky, Home health software. wellsky.com/home-health-software (read Oct 30, 2026)