The HIPPS code is wrong. The NOA was late. The LUPA just triggered.These are the three most expensive billing failures in home health — and all three are preventable with the right operational framework. For CY 2026, home health agencies face a -4.059% permanent PDGM rate adjustment plus a temporary 5% recoupment reduction. Margins are tighter than they have been since PDGM launched. The agencies that survive this environment are the ones whose billing teams understand PDGM deeply enough to protect every dollar of payment that accurate documentation earns.This handbook is the complete operational reference for home health and hospice billing professionals, revenue cycle directors, agency administrators, and compliance officers navigating the 2026 billing landscape.What's Inside:20 chapters covering the complete home health and hospice billing framework. The Patient-Driven Groupings Model explained from first principles — the five PDGM variables, 12 clinical groupings, HIPPS code generation, and how OASIS accuracy directly determines payment. OASIS-E guide covering which assessment items drive payment, how to score correctly, CASPER submission requirements, and the expanded July 1, 2025 requirement that OASIS is now mandatory for all payers — not just Medicare. The Notice of Admission — the 5-day submission deadline, the $41.26 per day late penalty, common NOA errors, and a same-day submission workflow that eliminates avoidable penalties. LUPA risk management — LUPA thresholds by clinical group, real-time visit tracking, proactive scheduling strategy, and the financial impact of first-period LUPA events. Homebound status documentation — the specific clinical language that survives audit and the generic statements that don't. Diagnosis coding for PDGM — how principal diagnosis selection determines clinical grouping, how comorbidity coding affects payment, and the diagnoses that do not map to PDGM groups. Hospice billing — the four levels of care with 2026 per-diem rates, the hospice election requirements, benefit period structure, recertification, General Inpatient Care documentation, and cap period monitoring. Physician billing for home health and hospice — G0180, G0181, G0182, CPT 99341-99350, and when each applies. Medicare Advantage home health — prior authorization requirements, OASIS for MA patients, network verification, and MA payment rates. The Home Health Value-Based Purchasing program — HHVBP quality measures, OASIS as a HHVBP driver, HHCAHPS, and the 5% payment adjustment. Denial management — ADR response, NOA denials, homebound documentation denials, and hospice denial patterns. Fraud and abuse risk — the most frequently investigated home health and hospice schemes, physician kickback arrangements, and the hospice cap. Four PDGM case studies with calculated financial impact. PDGM compliance audit tool with five sections. NOA and claim submission checklist. LUPA risk management worksheet. Homebound documentation template. PDGM denial reason code reference. Compliance calendar with annual, quarterly, and monthly tasks.This is the operational reference for billing professionals who submit home health and hospice claims every day and need a single accurate source for the PDGM payment system, OASIS documentation requirements, NOA timing rules, hospice per-diem billing, and the 2026 changes that are reshaping the financial landscape for every home health agency in the country.Not affiliated with or endorsed by CMS or NAHC.

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**Please note our transit times are from the date of dispatch.** We first started out as ?The Paperback Exchange,? a chain of physical bookstores where we would part exchange your beloved books for new stories to transport you to faraway places. However, as shopping started to evolve to online shops and marketplaces, we bid our stores goodbye to become ?PBShop.? This transition has only allowed us to blossom as we now ship thousands of titles to book lovers across the globe. We pride ourselves in being a community of local book lovers which allows our passion and devotion to shine in everything we do. In 2020 we not only celebrated our 20th birthday but our 1st birthday as being completely employee owned after becoming an E.O.T in September 2019. We are proud to be different and embrace standing apart on a book mountain by working from a virtual inventory which allows us to provide thousands of books that may be difficult to get for your bookshelf or your studies. Working with a number of different suppliers allows us to explore other avenues such as puzzles, sheet music and even stationery so we really do have something for everyone. Life is about being versatile in all realms of existence. If this is your first purchase with us, or you are a returning customer, we would like to welcome you to the PBShop family, for there is no friend as loyal as a book. We are a company who put our customers at the centre of everything we do as we understand the importance of reading because once you learn to read, you will forever be free. There are a whole lot of things in this world of ours that we are yet to explore, which is why we will forever inspire curious minds.

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Pbshop.co.uk
Unit 22 Horcott Industrial Estate, Horcott Road, Fairford, GL7 4BX, United Kingdom

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Returns Policy
We ask all customers to contact us for authorisation should they wish to return their order. Orders returned without authorisation may not be credited.
If you wish to return, please contact us within 14 days of receiving your order to obtain authorisation.
Returns requested beyond this time will not be authorised.
Our team will provide full instructions on how to return your order and once received our returns department will process your refund.
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Right of withdrawal

If you are a consumer you can withdraw from the contract in accordance with the following. Consumer means any natural person who is acting for purposes which are outside his trade, business, craft or profession.

Information regarding the right of withdrawal

Statutory right to withdraw

You have the right to withdraw from this contract within 14 days without giving any reason.

The withdrawal period will expire after 14 days from the day on which you acquire, or a third party other than the carrier and indicated by you acquires, physical possession of the last good or the last lot or piece.

To exercise the right of withdrawal, electronically fill in and submit a clear statement on our website, under "My Purchases" in "My Account". We will communicate to you an acknowledgement of receipt of such a withdrawal on a durable medium (e.g. by e-mail) without delay.

To meet the withdrawal deadline, it is sufficient for you to send your communication concerning your exercise of the right of withdrawal before the withdrawal period has expired.

Effects of withdrawal

If you withdraw from this contract, we will reimburse to you all payments received from you, including the costs of delivery (except for the supplementary costs arising if you chose a type of delivery other than the least expensive type of standard delivery offered by us).

We may make a deduction from the reimbursement for loss in value of any goods supplied, if the loss is the result of unnecessary handling by you.

We will make the reimbursement without undue delay, and not later than 14 days after the day on which we are informed about your decision to withdraw from this contract.

We will make the reimbursement using the same means of payment as you used for the initial transaction, unless you have expressly agreed otherwise; in any event, you will not incur any fees as a result of such reimbursement.

We may withhold reimbursement until we have received the goods back, or you have supplied evidence of having sent back the goods, whichever is the earliest.

You shall send back the goods or hand them over to PBShop.store UK, Fairford, United Kingdom, +44 1285 712917, without undue delay and in any event not later than 14 days from the day on which you communicate your withdrawal from this contract to us. The deadline is met if you send back the goods before the period of 14 days has expired. You will have to bear the direct cost of returning the goods. You are only liable for any diminished value of the goods resulting from the handling other than what is necessary to establish the nature, characteristics and functioning of the goods.

Exceptions to the right of withdrawal

The right of withdrawal does not apply to:

The delivery of newspapers, journals or magazines with the exception of subscription contracts; and
The supply of digital content which is not supplied on a tangible medium (e.g. on a CD or DVD) if you accepted when you placed your order that we could start to deliver it, and that you could not withdraw once delivery had started.

Shipping Terms

Orders are shipped from our UK warehouse. Delivery thereafter is between 4 and 14 business days. Please contact us if you have any queries about our services or products.

Shipping rates from United Kingdom to U.S.A.

Shipping rates from United Kingdom to U.S.A.
Order quantity	10 to 20 business days	10 to 20 business days
First item	� 4.16	� 4.16

Delivery times are set by sellers and vary by carrier and location. Orders passing through Customs may face delays and buyers are responsible for any associated duties or fees. Sellers may contact you regarding additional charges to cover any increased costs to ship your items.