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Therapy-specific prior authorization
Dedicated team by therapy class with payer policy tracking.
Industry · Home Infusion
Per-diem and per-drug billing without the reconciliation chaos.
Home infusion sits at the intersection of pharmacy, nursing, and DME billing. The combination of per-diem, per-drug, and nursing claims across multiple payer rules makes accurate, timely billing operationally complex.
Operational pain
Where the operation breaks down.
01
Split billing across pharmacy and nursing
Mismatched dates of service and missing nursing documentation triggering denials.
02
Prior authorization complexity
Therapy- and drug-specific authorizations, frequent re-auths, and payer policy drift.
03
MA and commercial plan variation
Inconsistent coverage rules requiring payer-specific intake workflows.
Reimbursement complexity
The payer landscape, plainly.
Per-diem coding, J-code accuracy, NDC-to-HCPCS crosswalks, and nursing visit billing must reconcile to the patient's clinical reality. Errors compound across the therapy duration.
Staffing reality
You cannot hire your way through this.
We provide infusion-experienced intake, prior-auth, and billing staff who understand the difference between an S-code and a J-code and how each payer treats them.
How we support home infusion operations
What an engagement actually delivers.
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Per-diem and per-drug billing reconciliation
Daily reconciliation between pharmacy dispense and nursing visit data.
03
Re-authorization tracking
Proactive renewal workflows to prevent therapy gaps and clean-claim breaks.
Operational outcomes
What stabilization looks like for home infusion.
Outcomes vary by baseline and segment. The numbers below are representative of mature home infusion engagements after six months.
Discuss Home Infusion OperationsHome Infusion Engagement Benchmarks
Days in A/R
34Median, post-stabilization
Clean-Claim Rate
96%First-pass acceptance
Denial Overturn
88%Inside the appeal window
Aggregate engagement performance. Individual results vary by segment and baseline.
Ready to stabilize your revenue operations?
Connect with our operational advisory team to evaluate your current intake-to-cash workflow and identify leakage points.
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