Platform / Health / Home Health
Healthcare Suite

Home Health Module
Referral to remittance. One system.

The full Medicare home-health agency workflow, built end to end: referral intake → OASIS-E (Medicare's required patient assessment) → CMS-485 plan of care → scheduled visits with EVV (electronic proof the visit happened) → PDGM billing (how Medicare decides what a visit episode pays) → QA review. Built in six stages, each one proven working on the running system before the next began.

● Live deployment 6 stages, each proven working 100+ automated tests Full OASIS-E instrument
What it replaces
Axxessthe full agency EMR, at a wedge price WellSkyreferral-to-claim workflow HCHBenterprise HHA operations, without the lock-in
The workflow

Every step a Medicare agency actually runs

Home health isn't generic EMR territory — it's a regulated pipeline where each document feeds the next. The module was built around that pipeline from day one, instead of bolting home-health forms onto a clinic chart.

📥Referral & admission

Intake that reads referral paperwork for you — AI pulls the key details out of referral narratives and faxed documents — plus patient creation on the spot, eligibility and homebound checks, then admission into a certification episode.

📝OASIS-E engine

The complete 188-item OASIS-E assessment — built directly from the official CMS guidance manual, not retyped by hand — with error checks, scoring, QA review states, locking, and a submission-ready export.

📄CMS-485 plan of care

All 26 sections of the form, including the real functional-limitation and activities-permitted checkbox grids; an AI draft that fills in blanks only, never overwrites; a printable form that matches the official layout exactly; and a physician e-sign portal with attestation.

📍Visits & EVV

Visit schedules generated straight from the plan-of-care frequencies, GPS-verified check-in and check-out capturing all six federally required visit-verification elements, and live transmission to the state's EVV collection system.

🧮PDGM billing

The system works out what each episode should pay under Medicare's rules, watches LUPA visit thresholds (the cutoff below which Medicare slashes payment), generates notices and claims in the standard electronic claims formats, codes diagnoses against the full official ICD-10 code set, and posts payer remittances with aging reports.

QA & coordination

QA review queues where nothing ships until it passes — returns go back with notes — plus care-team coordination notes and access controls built around real agency staffing: administrator, director of nursing, QA, intake, and every field discipline.

Revenue protection

AI engines that guard the margin

Home-health revenue leaks in known places — LUPA shortfalls, OASIS miscoding, late notices, claims sent back unpaid. The module ships a set of tools aimed squarely at those leaks, and the AI only ever suggests — the actual payment math is fixed, checkable arithmetic, the same every time.

  • Claim scrubber — a final check on every claim before it goes out, catching payment-code mismatches, LUPA episodes billed as full, unlocked OASIS assessments, unsigned certifications, and late notices before the payer ever sees them
  • LUPA monitor — ranks every open payment period from safe to critical, worst first, while there's still time to schedule the visit that saves the episode's payment
  • Eligibility assist — Medicare eligibility and homebound-status scoring at intake, flagging missing face-to-face and skilled-need documentation before you admit the patient
  • 485 builder & note templates — checks the plan of care for completeness, plus visit-note templates for each discipline that flag missing required elements

Everywhere AI appears, the rule is the same: AI drafts, a licensed clinician confirms. Nothing goes into the record or onto a claim without a human signing off.

By the numbers

188OASIS-E items — the complete assessment, nothing abridged
26CMS-485 sections, checkbox grids included
39 → 100+automated tests: 39 passing at the six-stage core, growing with every layer since
Verification

Six stages, each proven before the next

The build ran as a staged plan — foundation, referral/admission/episodes, OASIS-E, plan of care and orders, scheduling and EVV, then coordination, PDGM billing, and QA. Every stage was exercised end to end on the running system, not just checked in isolation, before moving on.

🔬Checked against the source

The OASIS-E assessment was built from the official CMS guidance manual and cross-checked against the published scoring scales — and that process caught and fixed a real coding-list error in an earlier draft. The 485 checkbox codes were verified against the official CMS form itself.

🔌Connections ready, credentials pending

Outside submissions — OASIS transmission, claims, eligibility — are fully built and simply waiting on each agency's own enrollment credentials: valid files in the standard electronic claims formats go out the day enrollment lands, and everything queues safely until then. EVV transmission to the state's collection system is fully live.

Sold two ways. The module ships inside the full SynergyEMR and as a standalone home-health edition for agencies — same engine, gated by practice type, with a native field app for the clinicians driving between visits.

Modern web platformEnterprise-grade databaseOASIS-E (188 items)PDGM payment groupingStandard electronic claims formatsGPS visit verificationBuilt-in AI (draft-assist)
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