Top 6 Home Health Billing Companies in San Antonio, TX (2026)

Home Health Billing Companies in San Antonio, TX: Side by Side

The Rules That Decide Whether a San Antonio Claim Gets Paid

11 Rules That Shape Home Health Billing in San Antonio

1. 1Medicaid managed care

   Most Medicaid members sit with a plan, not the state

   The Bexar service area has its own STAR+PLUS and STAR Kids plans. Each one sets its own enrollment process, authorization steps, and filing terms, and those terms are frequently shorter than the state's.
2. 2Dual eligible

   Medicare pays first on dual-eligible patients

   When both programs cover a service, the claim goes to Medicare first. The Texas Medicaid clock then runs from Medicare's decision, not from the date of service. Agencies lose money here more often than anywhere else, because the 95 days feel like they started months earlier than they did.
3. 3Texas Medicaid

   Ninety-five days, then nothing

   TMHP expects the claim within 95 days. Miss it without an approved delay reason, and there is no practical route back.
4. 4Texas Medicaid

   Visits have to match

   Texas requires electronic visit verification for Medicaid home health services, and a claim with no matching visit record is denied. Denials began with April 1, 2024 dates of service.
5. 5Texas Medicaid

   Authorization comes before the visit

   Fee-for-service skilled nursing and aide visits need approval first; an agency nurse must assess the client at home beforehand, and the Texas plan of care form applies rather than the CMS-485.
6. 6Medicare

   PDGM pays in 30-day periods

   The payment group is fixed at admission by diagnosis, admission source, timing, functional level, and comorbidities. A coding error there cannot be repaired on the claim.
7. 7Medicare

   Five days for the admission notice

   Medicare must accept one Notice of Admission within 5 calendar days of the start of care, and every late day cuts that period's payment.
8. 8Medicare

   Texas is a Review Choice state

   Agencies choose pre-claim or post-payment review. A 90% affirmation rate across at least 10 requests earns relief from most future review, which turns documentation quality into a cash flow question.
9. 9Medicare

   Palmetto GBA handles your claims

   Texas Home Health sits with Palmetto rather than NGS or CGS. Contractor portals and edits differ, so ask which ones a company works in every day.
10. 10Medicare

    LUPA thresholds move by group

    One visit under the threshold, and the period pays per visit. That starts in scheduling and surfaces as a billing number.
11. 11Texas licensing

    HHSC licenses you as an HCSSA

    Texas licenses home health agencies as Home and Community Support Services Agencies under 26 TAC Chapter 558, in categories including Licensed Home Health and Licensed and Certified Home Health. Your category determines what you can bill before a claim exists. Licensed-only agencies do not need Medicare certification to enroll with TMHP.

Where San Antonio Claims Break

How to Choose a Home Health Billing Company in San Antonio

Signals to Walk Away From

• A percentage quoted on billed charges rather than net collections
• Strong Medicare answers paired with vague Medicaid ones
• Collection rate promises with no client data behind them
• Fees that surface after signing, particularly for credentialing
• No read-only access to your own claim and payer systems

Keep It In-House or Outsource?

What You Will Pay in San Antonio

Mistakes San Antonio Agencies Make

1. 1

   Hiring a clinic biller

   Family medicine and internal medicine are office specialties billed per visit on a CMS-1500. Home health agency billing runs on 30-day periods and institutional claims. The skills do not transfer.
2. 2

   Billing Medicaid too early on dual patients

   The claim fails, and the clock keeps running. Sequence matters more here than anywhere else in the revenue cycle.
3. 3

   Treating managed care plans as interchangeable

   Each Bexar-area plan has its own authorization and filing terms. A biller who knows one does not automatically know the others.
4. 4

   Leaving old A/R unassigned

   Settle in the contract who works claims billed before go-live, and for how long.
5. 5

   Skipping the reference calls

   Two conversations with San Antonio agency owners will tell you more than any proposal.

How We Ranked These Companies

Final Picks

• Pick TruCare for referral-to-payment on one record with a published rate.
• Pick Patriot Medbill if TRICARE and Bexar County Medicaid plans are part of your payer mix.
• Pick CapitalMed Solutions if your revenue gap starts with coding and documentation.
• Pick One Source Medical Billing if you want billing and credentialing from one team with an office in San Antonio.
• Pick MediCommerce if billing, authorizations, and back-office work should sit together.
• Pick SwiftCare Billing if you want detailed home health coverage and will verify it yourself.

Frequently Asked Questions

TruCare Service Details

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