Question 1

What types of agencies does HDM work with?

Accepted Answer

HDM primarily works with home health care agencies that bill third-party payers, including the Department of Veterans Affairs, Medicaid, and commercial insurance. We serve agencies of all sizes across the United States, with deep expertise in the specific payer rules, authorization requirements, and EVV compliance challenges that home health agencies face every day.

Question 2

How do I know which HDM service tier is right for my agency?

Accepted Answer

The right fit depends on how involved your team wants to be in the billing process. Q+Bill is fully outsourced: HDM handles everything from submission to payment verification and appeals. Qwik+File PLU$ is a service-assisted model where claims are submitted electronically and HDM supports denial management. Qwik+File is client-managed with HDM providing setup, training, and ongoing guidance. We recommend scheduling a conversation with our team so we can review your current volume, payer mix, and staffing situation before making a recommendation.

Question 3

Does HDM work with agencies outside of Nebraska?

Accepted Answer

Yes. HDM serves home health agencies across the entire United States. Our team works remotely with clients nationwide, and the nature of electronic billing means geography is not a limiting factor. All of our work is U.S.-based.

Question 4

How long does it take to get started with HDM?

Accepted Answer

Onboarding timelines vary by service tier and the complexity of your current billing setup. Q+Bill and Qwik+File PLU$ require system access and a setup period to connect your practice management system and clearinghouse. Qwik+File includes some system setup and an initial training session before your team takes over. We recommend planning 30-60 days for complete setup. Contact us, and we can give you a more definite timeline based on your specific situation. If you have an immediate need, contact us, and we will see how we can help you.

Question 5

What agency management systems does HDM integrate with?

Accepted Answer

HDM can integrate with any agency management system. The most common systems we integrate with are Wellsky, VIV, and Axis Care. Most systems can produce standard EDI files, so integration is possible once we have the correct contact for the system vendor.

Question 6

What happens when a claim is denied?

Accepted Answer

The answer depends on your service tier. With Q+Bill, HDM pursues every denial, including filing appeals. With Qwik+File PLU$, denial follow-up is included for up to 3% of total claims, which is the industry standard threshold. Claims above that threshold are handled under Q+Rec at 10% of what is collected. With Qwik+File, your team manages denials with HDM available for consultation.

Question 7

What is Q+Rec and when does it apply?

Accepted Answer

Q+Rec is HDM's recovery service for previously denied, rejected, or unpaid claims. It applies when denials exceed the included threshold in Qwik+File PLU$, or when an agency has a backlog of old claims that were never resolved. HDM pursues recovery at 10% of what is collected. There is no fee if nothing is recovered.

Question 8

Does HDM handle VA and Medicaid claims specifically?

Accepted Answer

Yes. VA and Medicaid are the primary payers HDM works with for home health agencies. We understand the specific authorization requirements, EVV compliance rules, and payer-specific submission formats that these payers require. This specialization is one of the core reasons agencies choose HDM over a general medical billing service. In addition to the VA, HDM can work with any third-party payer as needed to obtain coverage for services the agency renders.

Question 9

What is the difference between a claim rejection and a claim denial?

Accepted Answer

There are two levels of claim rejection: clearinghouse rejection or payer rejection. A clearinghouse rejection happens before the claim reaches the payer, typically caught by the clearinghouse during front-end edits. It means the claim had a formatting or data error and was never adjudicated. A payer rejection happens at the front-end of the payer process where the payer checks for a "clean claim" based on their requirements. If the claim does not meet the payer's requirements, they reject the claim up front before it enters their adjudication process. These rejected claims never reach the payer's main system and generally are not found when a call is placed to the payer or a search is done on the portal. A denial happens after the payer receives and processes the claim, meaning they reviewed it and declined to pay for a clinical or administrative reason. Denials are returned on the remittance advice showing the claim or certain line items as unpaid. Both require follow-up, but the resolution process is different. Depending on the level of service, HDM handles both or provides guidance on proper handling when requested.

Question 10

Is HDM HIPAA compliant?

Accepted Answer

Yes. As a clearinghouse, HDM has been a HIPAA covered entity since the beginning of HIPAA requirements. We take the handling of protected health information seriously and have done so since Day 1. HDM even developed its own internal HIPAA training program, which is now publicly available as the Discovering HIPAA series.

Question 11

What is the Discovering HIPAA training series?

Accepted Answer

Discovering HIPAA is an online training program originally developed by HDM for its own internal staff. It is now available to other healthcare organizations and has been completed by over 300,000 healthcare professionals nationwide. It is available at discoveringhipaa.com.

Question 12

How does HDM handle protected health information?

Accepted Answer

As a clearinghouse and HIPAA covered entity, HDM follows all required safeguards for handling protected health information, including secure electronic data exchange, access controls, and compliance with the HIPAA Privacy and Security Rules. Our team is trained through the Discovering HIPAA program and our processes are built around PHI protection at every step.

Question 13

How is HDM's billing service priced?

Accepted Answer

Pricing varies by service tier and claim volume. Contact HDM for a pricing conversation based on your agency's situation.

Question 14

Does HDM charge if a claim is not collected?

Accepted Answer

For Q+Rec recovery services, HDM charges 10% of what is actually collected. If nothing is recovered, there is no fee. For standard billing service tiers, fees are based on service level and volume, not contingency.

Question 15

Is consulting available outside of a standard service tier?

Accepted Answer

Yes. HDM offers consulting at $95 per hour for any project related to third-party billing and collection. This includes process reviews, payer issue troubleshooting, billing audits, or any other billing-related project that does not fit a standard service tier.

Question 16

Will I have a dedicated account manager?

Accepted Answer

Yes. Every HDM client is assigned a dedicated account manager who works your claims. Your account manager knows your agency, your payers, and your claims. You will not be routed through a general support queue.

Question 17

How do I reach my account manager?

Accepted Answer

HDM account managers are available by phone and email. We prioritize responsive communication because we know that billing questions are time-sensitive. Contact details are provided during onboarding.

Question 18

Can HDM fill in if my billing staff is unavailable?

Accepted Answer

Yes. HDM offers PRN billing, which provides billing support on a fill-in basis when your staff is on leave, unavailable, or overwhelmed. PRN billing keeps your claims moving so your cash flow does not stall during staffing gaps.

Question 19

How do I get started with HDM?

Accepted Answer

The best first step is a conversation. Use the contact form on our Contact page or call us at 402-951-4503. We will ask about your agency's current billing situation, payer mix, and volume, and recommend the right service tier for your needs.

Your Questions About Home Health Billing, Answered

Getting Started

Billing and Claims

HIPAA and Compliance

Pricing and Contracts

Working With HDM

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