A Home Health Agency (HHA) workflow defines the structured sequence of clinical,
administrative, and billing activities required to deliver in-home healthcare services to
patients, primarily seniors and medically homebound individuals. This workflow ensures
compliance with healthcare regulations (e.g., Medicare), optimizes patient care, and enables
accurate billing and reporting.
🏠 Home Health Agency Workflow Overview
1. Referral & Intake
Goal: Receive and process patient referrals.
Sources: Hospital discharge planners, physicians, family, insurance providers.
Steps:
o Receive referral (via fax, email, portal).
o Verify patient eligibility (Medicare/insurance).
o Create patient chart in EMR.
o Assign Intake Coordinator/Nurse.
Key Documents:
o Referral form
o Face-to-Face Encounter documentation
o Physician Orders
2. Eligibility & Authorization
Goal: Confirm patient eligibility and obtain payer authorization.
Steps:
o Verify insurance coverage (Medicare Part A/B, Medicaid, private).
o Get prior authorizations if required.
o Check service coverage (e.g., skilled nursing, PT, OT, aide services).
Tools:
o Insurance portals
o Clearinghouse systems
3. Scheduling & Assignment
Goal: Assign clinicians and schedule visits.
Steps:
o Assign RN for Start of Care (SOC).
o Create visit schedule (weekly/bi-weekly).
o Coordinate among PT/OT/ST, home health aides, social workers.
Tools:
o EMR scheduling module
o Google Calendar/Outlook integration
4. Start of Care (SOC) Visit
Goal: Conduct initial assessment and develop care plan.
Performed by: Registered Nurse (RN) or Therapist
Key Activities:
o Comprehensive OASIS assessment
o Medication reconciliation
o Fall risk, pain, nutrition screening
o Initial Plan of Care (POC)
o Obtain patient consents
Form Used: OASIS-E, POC (CMS-485/EMR format)
5. Physician Certification
Goal: Obtain physician approval for the Plan of Care.
Steps:
o Submit POC to referring physician.
o Track and follow up on signed certification.
o Ensure compliance with 5-day submission rule.
Form: CMS-485, Physician Orders
6. Ongoing Visits & Care Delivery
Goal: Provide skilled home health services per POC.
Clinicians:
o RN, LPN, PT, OT, ST, MSW, HHA
Activities:
o Skilled nursing (wound care, IVs, vitals monitoring)
o Therapy sessions
o Home Health Aide support (bathing, grooming)
o Documentation after each visit
Tool: EMR visit note entry (via mobile/tablet)
7. Reassessment & Recertification
Goal: Evaluate patient progress and reauthorize services if needed.
Timeline: Every 60 days (Medicare episodic billing)
Steps:
o Conduct recertification OASIS
o Update POC if needed
o Submit to physician for recertification
8. Discharge or Transfer
Goal: End care episode properly.
Reasons:
o Goals met
o Hospitalization
o Patient choice
o Non-compliance
Steps:
o Complete discharge OASIS
o Final documentation and summary
o Notify physician and payer
9. Billing & Claims
Goal: Submit clean claims for reimbursement.
Steps:
o Generate RAP (Request for Anticipated Payment)
o Submit final claim after episode ends
o Track EOBs and payments
Tools:
o Medicare DDE, HETS, clearinghouse
o EMR-integrated billing modules
Billing Codes: HIPPS codes, Revenue codes
10. Quality Assurance & Compliance
Goal: Ensure care quality, regulatory compliance, and audit readiness.
Activities:
o QA/PI (Quality Assurance and Performance Improvement)
o Clinical documentation audits
o Survey readiness (e.g., CHAP, ACHC, Joint Commission)
Metrics Tracked:
o Star Ratings
o Hospitalization rates
o Patient satisfaction (HHCAHPS)
🧩 Diagram: Home Health Workflow Summary
text
CopyEdit
Referral ➝ Intake ➝ Eligibility ➝ Scheduling ➝ Start of Care ➝ POC
Approval ➝
Ongoing Visits ➝ Reassessment ➝ Discharge ➝ Billing ➝ QA/Compliance
📋 Key Forms & Standards
Document/Form Purpose
OASIS-E Clinical data collection
CMS-485 (POC) Plan of Care & Certification
Face-to-Face Encounter Medicare compliance
Visit Notes Daily clinical documentation
HIPPS Codes Billing & claim classification
HHCAHPS Patient satisfaction measure
Let me know if you want this in a flowchart diagram, or tailored for a specific EMR (like
Kinnser, WellSky, or Axxess).
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give me both
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✅ 1. Detailed Home Health Agency Workflow (Text
Description)
(Same as in the previous message, reformatted slightly for clarity)
🏥 Step-by-Step HHA Workflow
Step Process Description Roles Involved Tools/Documents
Receive patient referral
Intake Referral form, Face-
1 Referral & Intake from hospitals, physicians,
Coordinator to-Face document
or family.
Eligibility Verify Medicare/insurance, Insurance
2 Payer portals, EMR
Verification check patient criteria. Specialist
Submit and receive prior
3 Authorization Intake Team Pre-auth forms
authorization if required.
Scheduling & Assign SOC nurse and
4 Scheduler EMR, Calendar
Assignment schedule other disciplines.
Conduct initial OASIS
Start of Care
5 assessment and develop RN or PT OASIS-E, CMS-485
(SOC)
POC.
Physician Send Plan of Care to
6 Intake/Clinical POC (CMS-485)
Certification physician for signature.
Skilled nursing, therapy,
RN, PT, OT,
7 Ongoing Visits and aide visits begin as per EMR Visit Notes
ST, HHA
POC.
Perform 60-day
Reassessment & Recert OASIS, CMS-
8 reassessment and submit RN or PT
Recertification 485
new POC.
Discharge after goals met
9 Discharge or other reason. Final Clinician Discharge Summary
OASIS done.
Submit RAP/Final Claim to
10 Billing Billing Team HIPPS codes, EMR
Medicare/Insurance.
QA review, audit, ensure
HHCAHPS, Survey
11 QA/Compliance compliance & performance QA Team
Tools
reporting.
🧭 2. Home Health Workflow - Visual Flowchart
Here’s a simple flowchart image to visualize the workflow.
🟢 = Start of process
🔵 = Operational step
🟠 = Review or decision
🔴 = End point
🟢 Start
↓
🔵 Referral Received
↓
🔵 Intake & Eligibility Verification
↓
↙ ↘
🟠 Insurance Authorization Required?
Yes No
↓ ↓
🔵 Submit for Authorization 🔵 Schedule SOC
↓ ↓
↙ ↘
🟠 Authorization Approved? 🔵 Assign SOC Clinician
↓
Yes No 🔵 SOC Visit with OASIS
↓ ↓ ↓(go to schedule SOC)
🔵 Schedule SOC 🔴 End (Hold)
↓
🔵 Develop Plan of Care (POC)
↓
🔵 Send POC for MD Certification
↓
↙ ↘
🟠 POC Signed?
Yes No
↓ ↓
🔵 Begin Services 🔴 Hold Services
↓
🔵 Ongoing Visits & Documentation
↓
↙ ↘
🟠 60-Day Reassessment?
Yes No
↓ ↓
🔵 Recertification SOC → Continue Visits
↓ ↓
🔵 MD Signs Recert POC ↓
↓ ↓
🔵 Continue Visits ↓
↓
🟠 Patient Goals Met / Transfers / Hospitalization?
↓
🔵 Complete Discharge OASIS
↓
🔵 Final Claim Submission
↓
🔵 QA Review
↓
🔴 End
WellSky (Kinnser)
Axxess
MatrixCare
Alora
Homecare Homebase
