Operating system · Healthcare & Medical

Start and run a remote Medicare home health authorization & billing-integrity service — the plan, the playbooks, and the numbers already worked out.

The complete operating system for a remote, HIPAA-regulated back-office service that drafts authorization packets and pre-flags coding errors for home health agencies. It answers the distinction most newcomers botch — and lose agency credibility over: true prior authorization (Medicare Advantage) is a different regime from RCD pre-claim review (traditional Medicare) and from routine PDGM claim editing, and knowing which is which is the whole game.

What's inside

A banker-grade business plan covering the regulatory spine generic billing courses skip — the CMS-0057-F prior-auth clock (72-hour expedited / 7-calendar-day standard, effective Jan 1, 2026), the CMS-1828-F CY2026 HH PPS payment cut that's squeezing agency margins, the Review Choice Demonstration (RCD) pre-claim-review states, and the HIPAA Business Associate Agreement you sign with every client.

An editable Excel financial model — real, changeable assumptions (the ~$3,500/mo blended agency retainer, 40% labor COGS against ~60% gross margin, and the ~$200K of serviced volume one credentialed specialist supports per seat), not a static PDF.

Up to 17 operations playbooks — three-model pricing (per-packet, per-claim/percent-of-collections, monthly retainer) kept inside anti-kickback and False Claims Act norms; order intake inside the client's EHR (HCHB, MatrixCare, WellSky/Kinnser, Axxess, KanTime); the 48-hour packet turnaround and denial-overturn appeals workflow; and quality control against the 98%-coding-accuracy / 95%-affirmation bar.

Who it's for

Built for the biller, HCS-D or COS-C coder, or RCM specialist going independent to launch this support service — not the agency itself. Delivered instantly at checkout; single-buyer license. Editions differ by how many playbooks are included — compare the tiers below.

Choose your edition

Edition	What's included	Price
Starter	Business plan + financial model + essential playbooks	$149	Buy Starter
StandardMost popular	Plan + model + all 12 core operations playbooks	$299	Buy Standard
Premium	Plan + model + all 17 playbooks (core + growth & scale)	$499	Buy Premium
Custom	Premium, re-rendered around your real business and numbers	$1,500	At launch

Please read before purchasing. This product is an informational and educational operating system — a research-grounded business plan, operations playbooks, and an editable financial model. It is not legal, tax, accounting, financial, or investment advice, and using it does not create a professional-client relationship. Bytell Press does not guarantee any specific business, funding, or financial outcome. You are responsible for your own decisions and for consulting a qualified professional licensed in your jurisdiction before acting.