Home Care Billing in 2026: The Complete Guide for Home Health and Personal Care Agencies

Key Summary

Home care billing in 2026 has become more sophisticated, digital, and compliance-driven than ever. Whether you run a skilled home health agency (Medicare or Medicaid certified) or a non-medical personal care agency, accurate billing is crucial for getting reimbursed on time and avoiding audits or denials. This guide breaks down everything you need to know about home care billing — including payer types, billing systems, documentation requirements, claim submission steps, and compliance strategies — specifically tailored for agencies operating in the United States.

Need hands-on help? Book a licensing consultation to design a compliant billing workflow and payer setup for your agency.

Understanding Home Care Billing

Home care billing refers to the process of submitting and receiving payment for services delivered to clients or patients in their homes. Depending on your agency type and state licensure, billing may involve Medicare, Medicaid, Managed Care Organizations (MCOs), Veterans programs (VA), or private-pay clients.

Each payer type has unique billing procedures, codes, and requirements. Understanding these distinctions is essential before setting up your billing system.

Step 1: Identify Your Payer Sources

Home care billing varies based on who pays for the service. Agencies typically work with one or more of the following payer sources:

1. Medicare (For Skilled Home Health Agencies)

• Bills are submitted through the Medicare Administrative Contractor (MAC) assigned to your region. 
• Requires OASIS documentation, a signed Plan of Care (POC), and physician orders. 
• Claims are submitted through CMS electronic systems like the Home Health Prospective Payment System (HH PPS) or PDGM (Patient-Driven Groupings Model).
• Learn about PDGM under HH PPS at CMS PDGM overview.

2. Medicaid (For Skilled or Non-Medical Home Care)

• Billed through each state’s Medicaid portal or MMIS (Medicaid Management Information System).
• Non-medical home care providers (Personal Care Attendants, Homemakers, Companions) often bill through waiver programs or Managed Care Organizations (MCOs).
• Most states now require Electronic Visit Verification (EVV) to confirm caregiver clock-in and clock-out times.

3. Managed Care Organizations (MCOs)

• Many states have transitioned home care services to Managed Medicaid Plans (e.g., UnitedHealthcare, Amerigroup, Molina, Centene).
• Each MCO has its own billing portal, claim format, and pre-authorization rules. 

4. Private Pay or Long-Term Care Insurance

• Clients pay directly or through private insurance policies.
• Agencies must issue invoices, maintain signed timesheets, and often accept payment through third-party billing software.

5. Veterans Affairs (VA) and Other Programs

• Home care services may be billed through Veterans Home and Community-Based Care programs or VA CCN (Community Care Network). 

Step 2: Set Up a Home Care Billing System

Billing for home care services requires a structured workflow and reliable billing software.

Essential Billing Tools and Systems for 2026

• Electronic Health Record (EHR) or Agency Management Software (e.g., AlayaCare, WellSky, CareSmartz360, AxisCare)
• Electronic Visit Verification (EVV) system integrated with billing
• Clearinghouse connection for electronic claim submission (e.g., Office Ally, Availity)
• Payroll and Scheduling Sync to match visits with claim data
• Automated compliance alerts to prevent billing of unauthorized or expired care plans

Automation in billing has become the industry standard in 2026 — reducing errors, preventing underbilling, and ensuring compliance with both CMS and state regulations.

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