Why Medicare Audits Are Increasing for Home Health in 2025 — And How Proper Billing Protects You
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Medicare audits are rising sharply in 2025 — and home health agencies are feeling the pressure more than ever. From PDGM documentation errors to EVV inconsistencies, CMS has increased oversight, risk scoring, and automated claim monitoring.
For agencies without strong billing and compliance systems, this means:
❌ Higher denial rates
❌ Payment holds
❌ Revenue recoupments
❌ Increased administrative burden
But with a trusted partner like Everest A/R Management Group, your agency can operate with confidence, compliance, and financial stability.
Why Medicare Audits Are Increasing in 2025
Stricter PDGM Monitoring
CMS is targeting:
Unsupported diagnoses
Incorrect functional impairment scoring
OASIS inconsistencies
Excessive LUPA frequency
Even small errors now trigger Targeted Probe & Educate (TPE) audits.
EVV Failures Are Becoming Audit Triggers
Home health agencies are being flagged for:
Incomplete visit verification
Mismatched timestamps
Missed EVV documentation
Inaccurate caregiver mapping
CMS now considers EVV lapses a high-risk indicator.
Claims Pattern Analysis Is More Aggressive
AI-based Medicare analytics identify:
High-utilization patterns
Suspicious billing frequency
Outlier diagnoses
Repetitive documentation trends
Honest agencies often get caught in these automated sweeps.
NOA/RAP Errors Are Causing Automatic Holds
Late or incorrect NOAs result in:
Delayed reimbursement
Claim rejections
Additional medical review
Cash-flow interruption
With tighter 2025 requirements, errors have skyrocketed.
The Financial Impact on Home Health Agencies
When a Medicare audit hits, agencies experience:
15–30% revenue loss
Weeks or months of delayed payments
Staff pulled away from patient care
Risk of extended audits
For small and mid-sized agencies, this can be devastating.
How Everest A/R Management Group Protects You From Medicare Audits
PDGM Coding That Passes Every Compliance Check
Our certified coders ensure:
Proper diagnosis sequencing
Fully supported clinical documentation
Aligned OASIS + coder review
Accurate functional scoring
This eliminates the top PDGM audit triggers.
Error-Free NOA/RAP Management
Never miss a deadline again.
Everest ensures:
Real-time submission
Clean intake data
Correct HIPPS codes
Zero compliance gaps
Your claims move smoothly through Medicare.
EVV Reconciliation That Prevents Audit Flags
We verify every visit with:
EVV-to-documentation matching
Missing timestamp correction
Discrepancy alerts
Visit validation
No more EVV red flags or inconsistencies.
Internal Compliance Audits Before CMS Reviews You
Everest performs proactive audit checks including:
Chart review
Coding accuracy
Documentation matching
Modifier + G-code validation
PDGM grouping integrity
Your agency stays consistently audit-ready.
Clean Claims That Reduce Audit Risk by 60%
Great billing does more than get claims paid —
It prevents your agency from being selected for audit.
Everest ensures:
Clean, compliant claims
Fully supported documentation
Accurate clinical justification
Correct frequencies and utilization
Why Home Health Agencies Choose Everest A/R Management Group
With Everest as your revenue cycle partner, you get:
✔ 24/7 AR management
✔ Faster reimbursements
✔ 30–40% fewer denials
✔ 20–35% increase in cash flow
✔ 70–90% fewer audit errors
✔ Full Medicare compliance support
Everest helps home health agencies grow without fear of Medicare audits harming their financial stability.
Conclusion
Medicare audits will continue rising through 2025 — but with Everest A/R Management Group on your side, your agency stays protected, compliant, and financially strong.
