Home health billing solutions is a make-or-buy question with a payer in the middle: the make-or-buy decision across software and services. This page is for the agency owner deciding whether claims belong in-house or with a service, and it treats the decision as arithmetic: what a service really prices, where denials actually come from, and which records must stay the agency's own whoever submits the claim.
Percentage-of-collections, and what it hides
Most billing services price as a percentage of what they collect. That aligns incentives on volume and hides them on the hard claims: a service paid on collections has no appetite for the 90-day-old denial that needs an appeal. Ask specifically who works denials older than 60 days and what their write-off policy is, because that is where agencies quietly lose their margin.
The paperwork the biller will demand from you
Medicare's conditions of participation require each plan of care to be reviewed and revised no less frequently than once every 60 days from the start of care (42 CFR 484.60). No billing service can collect against a stale plan or an unverified visit: the plan of care, the orders and the EVV record are the inputs, and they are yours. Agencies that outsource billing and keep sloppy paperwork just pay a percentage for their own denials.
Outsource the claims, never the record
Whoever submits the claims, the client record, the plans and the audit trail must stay yours, exportable, in your own system. A billing relationship should be replaceable in a quarter; if leaving your biller means losing your history, you hired a landlord, not a vendor.
When in-house wins
Below a certain claims volume the percentage beats a salary and outsourcing wins. Past it, an in-house biller who knows your payers beats the service's queue. The crossover is your arithmetic, not the vendor's: claims per month, your current denial rate, and what a full-time biller costs in your market. Work it before the sales call, not after.
Questions people ask about home health billing solutions
Will a billing company fix our denials?
It will work them; whether it fixes the cause depends on you. Most denials in this trade trace to the agency's own paperwork: expired orders, missed 60-day plan reviews, visits that failed EVV. A biller can chase those; only the agency can stop producing them.
Do we still need software if we outsource billing?
Yes. The plan of care, the roster, the visit record and the audit trail remain the agency's to keep, and the biller consumes them. Outsourcing the claims without keeping your own record just makes the biller your single point of failure.
What percentage do billing services charge?
The category typically prices as a share of collections, quoted per agency; published list prices are rare. Whatever the quote, the comparison that matters is percentage against your current denial write-offs plus the loaded cost of doing it in-house.