Home Health
Approved care,delivered visits,in agreement.
Home health agencies answer to commercial plans, Medicare Advantage, Medicaid, and traditional Medicare at once, each with its own rules. Circle helps agencies confirm what each payer approved, support skilled need in every visit, and reconcile completed care against the authorization before claims go out.
100%
Chart review coverage
Precertification gets visits approved. It does not guarantee payment. Circle helps agencies support skilled need in every visit and reconcile completed care against authorizations before claims go out.
Reimbursement structure
Commercial and Medicare Advantage plans often require precertification by service, with approved visits tied to a discipline and date range. Traditional Medicare pays in 30-day periods with 60-day certification episodes. Medicaid adds state-specific eligibility and authorization rules.
Common criteria evaluated
- Commercial precertification lists
- Delegated utilization review
- Medicare Home Health CoPs
- OASIS
- Face-to-face requirements
- State licensing
How it works, in the daily work.
Authorization tracking
- Complete
Visits approved
6 skilled nursing visits
- Complete
Visits completed
5 of 6 used
- Review needed
Visits scheduled
2 more booked past the approval
- Missing
Extension request
Not yet submitted
Built into every review.
Approved vs. delivered care
Authorized visits, disciplines, and date ranges compared against scheduled and completed visits, with extensions flagged early.
Commercial precertification
Each plan's precertification list and delegated review route held separately, so packets are complete before submission.
Skilled care evidence
Each visit reviewed for the skilled service and the reasoning behind it, with maintenance care treated as covered care.
Medicare certification timelines
Face-to-face encounters, certifications, and 60-day recertifications tracked where traditional Medicare rules apply.
Ready for reviews and records requests
Complete, dated records assembled quickly when a plan, contractor, or auditor asks for documentation.
Clinicians stay in control
Circle organizes the evidence. Coverage decisions and signatures stay with clinicians, and it works alongside the EMR.
What customers have measured.
100%
Chart review coverage
70%
Less time to a compliant note, expanding clinical capacity
As reported by Circle customers
2M+
Records processed
Explore further
Who we serve
Hospice Care
Eligibility, approvals, and levels of care kept in agreement across every payer.
Solution
Pre-Bill and Record Reviews
Documentation gaps caught before billing, and records ready for payer reviews.
Solution
Compliance and QA
Every active chart reviewed while the client is still in care.
Know what each payer expects. Act before revenue is at risk.
See how Circle fits alongside the systems already in place.
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