Home Health
Approved care,delivered visits,in agreement.
Home health agencies answer to commercial plans, Medicare Advantage, Medicaid, and traditional Medicare at once, each with its own rules. Circle helps agencies confirm what each payer approved, support skilled need in every visit, and reconcile completed care against the authorization before claims go out.
100%
Chart review coverage
OASIS assessments, care plans, and visit notes must tell a consistent story. Circle helps teams align the record with payer requirements before claims go out.
Reimbursement structure
Commercial and Medicare Advantage plans often require precertification by service, with approved visits tied to a discipline and date range. Traditional Medicare pays in 30-day periods with 60-day certification episodes. Medicaid adds state-specific eligibility and authorization rules.
Common criteria evaluated
- Commercial precertification lists
- Delegated utilization review
- Medicare Home Health CoPs
- OASIS
- Face-to-face requirements
- The Joint Commission (TJC)
- State licensing
How it works in your daily routine.
Approved vs. delivered
Approved care and completed visits, side by side
Authorized visits, disciplines, and dates compared against what was scheduled and completed, so extensions are requested before a visit falls outside the approval.
Authorization tracking
- Complete
Visits approved
6 skilled nursing visits
- Complete
Visits completed
5 of 6 used
- Review needed
Visits scheduled
2 more booked past the approval
- Missing
Extension request
Not yet submitted
Built into every review.
Approved vs. delivered care
Authorized visits, disciplines, and date ranges compared against scheduled and completed visits, with extensions flagged early.
Commercial precertification
Each plan's precertification list and delegated review route held separately, so packets are complete before submission.
Skilled care evidence
Review the skilled service, why it was needed, and what needs clarification before billing. For Medicare, improvement is not a prerequisite when skilled maintenance care meets coverage requirements.
Medicare certification timelines
Face-to-face encounters, certifications, and 60-day recertifications tracked where traditional Medicare rules apply.
Ready for reviews and records requests
Bring together dated records supporting skilled need, certification, and care delivered for Additional Documentation Requests (ADRs), payer reviews, and audits.
Clinicians stay in control
Circle organizes the evidence alongside the EMR. Your care team retains clinical judgment, reviews findings, and signs the documentation.
What customers have measured.
100%
Chart review coverage
70%
Less time to a compliant note, expanding clinical capacity
As reported by Circle customers
2M+
Records processed
Explore further
Know what each payer expects. Act before revenue is at risk.
See how Circle fits alongside the systems already in place.
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