Home Health Billing in Florida

Yes. Florida runs no-fault auto coverage, which changes who pays first for an injury claim — and that matters more in home health than in most specialties. Medicaid runs as Statewide Medicaid Managed Care (SMMC), delivered largely through commercial managed care plans. So most Florida Medicaid claims are adjudicated by an insurer with its own filing window, its own authorization rules, and its own appeal path — not by the state. Nationally about 78% of Medicaid beneficiaries sit in comprehensive managed care, and five companies hold roughly half of that enrollment.

Palmetto GBA (JM home health and hospice). Home health and hospice claims have their own Medicare contractors, separate from the Part A/B contractor for Florida. It processes the claims, publishes the local coverage determinations that bind you, and hears the first level of appeal.

The specialty causes first: physician did not certify the plan of care inside the window; face-to-face encounter not documented; visit frequency exceeding the plan of care. On top of those, Florida Medicaid runs through commercial plans, so filing windows and authorization rules vary by plan rather than by program.

Florida is a no-fault state. For an auto injury the auto carrier is the payer of first resort, not the health plan. Billing the health plan first produces a denial that reads like a coverage problem but is a sequencing problem, and by the time it arrives the auto carrier's own window has been running.

Florida restricts percentage-based arrangements on Medicaid dollars. Our pricing in Florida is set accordingly, and it is confirmed in writing before any work begins. That describes what we charge; your own position is a question for your counsel rather than for us.

Yes. All coding is performed by certified coders credentialed through the AAPC or AHIMA, working from the documentation you provide. Episode-based billing where the physician must certify and re-certify the plan of care inside defined windows.