Home Care Billing in Pennsylvania

Regulatory Agency

Pennsylvania Department of Human Services, Office of Medical Assistance Programs

Key Requirements

• Enroll as a Medicaid provider with your state Medicaid agency
• Obtain National Provider Identifier (NPI) for billing
• Implement HIPAA-compliant billing systems and electronic health records
• Use correct CPT/HCPCS codes for home care services
• Maintain proper documentation to support all billing claims
• Submit claims within your state's timely filing deadline
• Comply with prior authorization requirements for applicable services
• Implement compliance program to prevent fraud, waste, and abuse

Fees

Billing software costs $100-$500/month; clearinghouse fees vary

Tips

Invest in a good billing software system designed for home care. Train all staff on proper documentation requirements. Contact Pennsylvania Department of Human Services, Office of Medical Assistance Programs for the current fee schedule and billing manual. Consider outsourcing billing to a specialized home care billing company if you're just starting out.

Key Regulations

Medicaid billing in Pennsylvania is governed by Pennsylvania Department of Human Services, Office of Medical Assistance Programs. Reimbursement rates vary by service type and are published in the state's fee schedule. Home care providers must comply with federal anti-kickback, Stark Law, and False Claims Act requirements.