Specialty: Home Health Care
Service Offering: Full-Service Billing
Practice Management Software: Alora
Introduction
This case study explores how a medium-to-large Home Health Care provider transformed its revenue cycle operations by partnering with a specialized medical billing company. The result was faster payments, reduced denials, improved compliance, and increased monthly revenue.
Background
The provider offers skilled nursing, physical therapy, occupational therapy, and home health aide services to a growing base of post-acute and chronically ill patients across multiple counties. While the clinical services continued to scale, the internal billing team struggled to keep pace, resulting in increased accounts receivable, delayed payments, and compliance concerns.
Revenue Cycle Challenges
- High Volume of Unbilled Visits: Delays in clinician documentation and communication lapses caused service visits to remain unbilled for extended periods.
- Incomplete OASIS Documentation: Inaccuracies and omissions in OASIS assessments delayed RAP/NOA submissions and final claims.
- Ineffective NOA/NOE Tracking: Late or missed Notice of Admission submissions triggered penalties and reimbursement denials.
- Poor A/R Follow-Up: The internal team lacked the bandwidth to consistently follow up on aging claims and resolve payer issues.
- Limited Use of Value-Based Services: The agency was underbilling for eligible services like remote patient monitoring, care plan oversight, and TCM visits due to a lack of awareness or billing expertise.
Objectives
- Reduce Billing Delays: Ensure timely submission of NOA, RAP, and final claims by streamlining documentation and billing workflows.
- Improve Cash Flow: Accelerate reimbursements through better charge capture, eligibility checks, and claim tracking.
- Enhance Documentation Accuracy: Improve clinician education and documentation review for OASIS and visit notes to reduce rejections and denials.
- Strengthen A/R Recovery: Implement robust processes for denial management and aged claim follow-up.
- Maximize Reimbursable Services: Identify and bill for all eligible services including care coordination and chronic care management.
Intervention
The medical billing company introduced a tailored, multi-level intervention for the home health care provider:
- Integrated Clinical-Billing Workflow: Mapped clinician workflows with billing processes to reduce the turnaround time from visit completion to claim submission.
- OASIS & NOA Compliance Audits: Established a dedicated review team to check OASIS documentation and ensure timely NOA filing in accordance with CMS timelines.
- Real-Time Eligibility Verification: Automated patient eligibility checks at intake to prevent future denials due to inactive or ineligible insurance.
- Dedicated Denial Resolution Unit: Assigned a team specifically focused on denial trend analysis, appeals, and working rejections within payer timeframes.
- Revenue Optimization Review: Identified missed billing opportunities for services like TCM, CCM, RPM, and care plan oversight and integrated them into routine billing.
Results
| Metric | Before Implementation | After Implementation | Improvement (%) |
|---|---|---|---|
| Claim Submission Turnaround Time |
6 days | 1.5 days | 75% |
| Clean Claim Submission Rate | 82% | 96% | 17% |
| Working on denied Claims | 35% | 12% | 66% |
| Denial Rate | 18% | 6% | 67% |
| Average Payment time | 50 days | 25 days | 50% |
| Monthly Revenue | $400,000 | $525,000 | 31% |
Conclusion
By partnering with a medical billing company equipped to handle the complexities of Home Health Care billing, the provider achieved remarkable gains in operational efficiency and financial performance. These improvements enabled the agency to expand services, improve clinician productivity, and provide a better patient experience—while maintaining compliance with evolving Medicare regulations.
