· Reviewed by Nimra Khalid
What is home care billing outsourcing?
Home care billing outsourcing means a remote team turns your agency's confirmed visits into paid claims. It covers matching visits to electronic visit verification records, checking authorized units, submitting claims to Medicaid, managed care organizations and private payers, posting remittances and working denials. The agency keeps its own scheduling and EVV system; the provider works inside it.
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Home care billing: what we do and how it runs
Home care billing outsourcing means a remote team turns your agency's confirmed visits into paid claims. It covers matching visits to electronic visit verification records, checking authorized units, submitting claims to Medicaid, managed care organizations and private payers, posting remittances and working denials. The agency keeps its own scheduling and EVV system; the provider works inside it.
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What it is
Home care billing outsourcing means a remote team turns your agency's confirmed visits into paid claims. It covers matching visits to electronic visit verification records, checking authorized units, submitting claims to Medicaid, managed care organizations and private payers, posting remittances and working denials. The agency keeps its own scheduling and EVV system; the provider works inside it.
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What you get
Every visit matched to EVV, authorization and rate before it is billed
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How it runs
Medicaid, MCO, waiver, VA and private-pay claims from one team
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Billing audit call
A 30-minute call to map your payers, programs, states, EVV aggregator, scheduling system and visit volume. We look at a sample of recent rejections and your current unbilled-visits list.
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A named accountant, a backup and a team lead
Inside your own software, on a fixed close calendar, with a reply from a person within 1 business day. Call +1-657-777-0006 or start a quote.
Book a billing audit 06 / 06
Who it is for
Agency owners
You run a non-medical home care or home health agency and billing happens in a weekend rush. Unbilled visits and rejected claims are quietly eating your cash.
Office and billing managers
One person handles scheduling, EVV exceptions and claims. When they are out, nothing gets billed. A dedicated remote biller gives that role a backup and a routine.
Multi-state and multi-payer agencies
Different Medicaid portals, MCO rules and EVV aggregators in each state need one process, one exception log and one report.
What's included
- Daily reconciliation of scheduled visits against EVV-confirmed visits
- EVV exception clearing with your schedulers before the billing cutoff
- Authorization tracking with remaining units reported weekly
- Medicaid fee-for-service, MCO and waiver program claim submission
- VA community care, long-term care insurance and private-pay invoicing
- 835 remittance posting with adjustments coded by reason
- Rejected and denied claims corrected and resubmitted within timely filing
- Insurance and program AR follow-up by payer and aging bucket
- Rate table maintenance when payer rates or service codes change
- Billed hours tied to payroll hours every pay period
- Monthly reconciliation of remittances to bank deposits and the ledger
- Weekly unbilled-visits report with an owner for every item
Deliverables and KPIs
| Deliverable | KPI we report | Cadence |
|---|---|---|
| Visits billed | Visits billed within 48 hours of EVV confirmation | Daily |
| EVV exceptions cleared | Every unmatched visit assigned to a scheduler within 1 business day | Daily |
| Authorization tracking | No visit billed beyond authorized units without a flag to the agency | Weekly |
| Remittances posted | 835s posted within 1 business day of receipt | Daily |
| Denials worked | Every denial touched within 5 business days with a next action | Weekly |
| Billing-to-payroll tie-out | Billed hours reconciled to paid caregiver hours with variances explained | Per pay period |
KPIs are what we measure and report, agreed per engagement. Service-level commitments are set in your agreement.
How it works
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Billing audit call
A 30-minute call to map your payers, programs, states, EVV aggregator, scheduling system and visit volume. We look at a sample of recent rejections and your current unbilled-visits list.
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BAA, access and payer setup
We sign a business associate agreement and you grant role-based access to your agency software, EVV portal, Medicaid and MCO portals. Rate tables, service codes and authorization sources are confirmed in week one.
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Dedicated biller assigned
A named biller, a trained backup and a team lead take over the daily visit reconciliation and claim runs. The first billing cycle runs in parallel with your current process.
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Daily cycle, monthly reconciliation
Visits are reconciled and billed every business day, remittances posted as they arrive and denials worked weekly. At month-end the team ties remittances to deposits and your ledger and sends a short report on what changed.
Software we work in
How much does home care billing cost?
Home care billing is commonly priced as a percentage of collections, per claim or per visit, or per dedicated biller, depending on visit volume and payer mix. We quote the model that fits your agency, and engagements run month-to-month. Pricing depends on volume and scope, so we send a custom quote within 1 business day.
What moves the quote
- Monthly visit volume and number of billable service codes
- Number of states, Medicaid programs and MCOs you bill
- Whether EVV exception clearing is included or handled by your schedulers
- Size of the unbilled and denied backlog at the start
Market benchmarks
| Market | Typical range | Source |
|---|---|---|
| US | Dedicated offshore billing staff typically run $8 to $35 per hour all-inclusive, against $40 to $75 per hour for US-based staff | Madras, Acculink, Rose Talent (2026) |
Third-party ranges for orientation, not our prices.
Book a billing audit No setup fee. Month-to-month.
Home care billing for your industry
Case study
90+ day AR down 62%
Case studyCutting 90+ day AR by 62% for a home-care agency
A home-care agency in the Midwest billed a mix of Medicaid waiver programs, managed-care plans, long-term care insurance and private-pay families. Claims went out, but nobody owned the follow-up. Denials sat in the clearinghouse, family invoices were sent once and forgotten, and the 90+ day bucket grew every month. The agency engaged LedgerBPO for home-care billing, accounts receivable and AR follow-up calls. A named billing specialist, a backup and a team lead worked inside the agency's scheduling software, clearinghouse and QuickBooks Online. Over the engagement the 90+ day AR balance fell by 62%. The agency did not add staff, change payers or switch software. It added a team whose only job was to bill cleanly and follow every unpaid claim and invoice to a resolution.
Security and compliance
- HIPAA-trained staff, a signed BAA, and minimum-necessary access to client records
- MFA on every login, per-client access logs, no data on local devices or paper
- We never move money; payer remittances land in your bank, never ours
Full control list on the security page and country rules on the compliance page. Certifications are listed only when held.
Frequently asked questions
How much do home care billing services cost?
Pricing depends on volume and scope, and we send a custom quote within 1 business day. Home care billing is commonly priced as a percentage of collections, per claim or visit, or per dedicated biller, and we recommend the model that fits your visit volume and payer mix. As a market reference, dedicated offshore billing staff typically cost $8 to $35 per hour all-inclusive (Madras, Acculink, Rose Talent, 2026).
Do you work inside AxisCare, WellSky, Alora or HHAeXchange?
Yes. We work inside your existing agency management and EVV system rather than exporting data into ours. You keep the subscription and the data. Claims are generated from your system and submitted through your Medicaid or MCO portals, so nothing about your payer relationships changes.
How do you handle EVV exceptions?
Every scheduled visit is compared with its EVV record each business day. Missed clock-ins, GPS mismatches, wrong service codes and duplicate visits go into an exception log and are sent to your schedulers with a due date before the billing cutoff. Nothing is billed until the exception is resolved or the agency approves a manual correction.
Can you track authorizations so we do not overbill?
Yes. Authorized units, start and end dates and service codes are tracked per client, and remaining units are reported weekly. If a schedule would take a client past their authorization, the biller flags it to the agency before the visit is billed, and our prior authorization services team can request the extension.
What happens to our old denied and unbilled claims?
We start with a backlog sprint. Unbilled visits and denied claims are sorted by payer, age and timely-filing risk, corrected and resubmitted where possible, and listed with a reason where they are not. You receive a written summary and approve any adjustment before it is posted.
Do you also bill private-pay clients and long-term care insurance?
Yes. Private-pay invoices, long-term care insurance claims with the supporting care notes, and VA community care claims are all part of the service. Private-pay reminders and family billing questions can be handled under your agency name through our patient billing call center.
Can you tie billed hours to caregiver payroll?
Yes. Each pay period the biller compares billed hours with hours paid to caregivers and lists every variance, such as unpaid travel time or unbilled overtime. This is the check most agencies are missing, and it is where margin leaks show up first.
Is this part of SS Support Network?
Yes. LedgerBPO is the accounting and billing division of SS Support Network LLC, our healthcare BPO sister brand (sssupportnetwork.llc) that provides front-office and call-desk support to healthcare providers. If you need front-office support as well as billing, one team can cover both under one agreement.
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